NHS Dudley Health Economy Medicines Formulary
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3.2 Corticosteroids

General guidance

  • Corticosteroids reduce airway inflammation and are effective in reducing both severity and frequency of acute asthma episodes.
  • Corticosteroids are generally less effective in those with chronic obstructive pulmonary disease (COPD). Whether inhaled corticosteroids reduce the decline in lung function in COPD has not yet been established. However, since there is considerable overlap between asthma and COPD a therapeutic trial of inhaled corticosteroids measured against objective response criteria is worthwhile in many of those with COPD.
  • Inhaled corticosteroids are recommended for prophylactic treatment of asthma when patients are using a beta2-adrenoceptor agonist more than once per day. Although inhaled agents have far less potential for causing adverse effects than orally administered agents the potential for adrenal suppression should be remembered at higher doses.
  • The need to use inhaled corticosteroid preparations regularly must be emphasised to patients; alleviation of symptoms usually takes 3-7 days after initiation to become apparent.
  • If the inhaled corticosteroid induces coughing, the use of a beta2-adrenoceptor agonist prior to the corticosteroid may help.
  • Patients who have been taking oral corticosteroids for prolonged periods an often be transferred to an inhaled agent if the transfer is done slowly with a gradual reduction in oral corticosteroid at a time when the asthma is well controlled.
  • High dose inhaled corticosteroids are available for those who experience only a partial response to lower doses. However, at these dosages a degree of adrenal suppression may occur therefore such patients should receive a steroid warning card. In addition, it is important to ensure that the need for high dose inhaled corticosteroid therapy in such patients is reviewed regularly and especially if the asthma has been stable for a few weeks.
  • At equipotent dosages the incidence of adverse effects appears to be similar between beclomethasone, budesonide and fluticasone. However, fluticasone may have a role in those requiring long term high dose inhaled corticosteroid therapy.


Asthma Formulary inhalers

Please refer to full guidelines for further information 

Asthma acute management guideline

Asthma treatment guideline

Asthma treatment guideline - MART and LAMA

Asthma treatment guideline - Poster

Asthma treatment guideline - Quick 4 pager

Asthma treatment guideline - Stepping down treatment in adults


COPD Formulary inhalers

COPD treatment guidelines

COPD treatment guidelines - Poster

Spacer devices leaflet

Prescribe inhaler medication by brand



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