Patient education: Inhaled corticosteroid medicines (The Basics)

What are inhaled corticosteroids? — Inhaled corticosteroids are sprays or powders you breathe in using a device called an "inhaler." They are also called "steroid inhalers." They are used to treat breathing problems like asthma and chronic obstructive pulmonary disease ("COPD"). They work by reducing swelling, or "inflammation," in your lungs.

Inhaled corticosteroids are also called "controller" or "preventer" inhalers. That's because they help prevent flares of shortness of breath and wheezing.

Other steroid medicines come as pills, shots, nose sprays, or creams. This article is only about inhaled corticosteroids.

What are some common inhaled corticosteroids? — Examples include:

●Beclomethasone (brand name: QVAR)

●Budesonide (brand name: Pulmicort)

●Ciclesonide (brand name: Alvesco)

●Fluticasone (brand names: ArmonAir, Arnuity, Flovent)

●Mometasone (brand name: Asmanex)

Corticosteroids are sometimes combined with medicines called "bronchodilators" in the same inhaler. Bronchodilators help open the airways. Using a combination inhaler makes it easier to take both medicines at the same time. Some bronchodilators are "long acting" and others are "short acting." Examples of these combination inhalers include:

●Budesonide-albuterol (brand name: Airsupra)

●Budesonide-formoterol (brand names: Breyna, Symbicort)

●Fluticasone furoate-vilanterol (brand name: Breo)

●Fluticasone-salmeterol (brand names: Advair, Airduo, Wixela)

●Mometasone-formoterol (brand name: Dulera)

●Budesonide-glycopyrrolate-formoterol (brand name: Breztri)

●Fluticasone furoate-umeclidinium-vilanterol (brand name: Trelegy)

When do I use a corticosteroid inhaler? — Use your inhaler as your doctor prescribes it. Most people use corticosteroid inhalers to prevent breathing problems. For this to work, they should be used every day, even when you are not having trouble breathing.

A few inhalers contain both a corticosteroid and a medicine called formoterol. Formoterol is a "long-acting" bronchodilator that also works to relieve symptoms quickly. Some people use these every day to prevent breathing problems, plus extra doses for quick relief of symptoms when needed. Some people only need to use them sometimes, when they are having trouble with their breathing. They include:

●Budesonide-formoterol (brand names: Breyna, Symbicort)

●Mometasone-formoterol (brand name: Dulera)

One inhaler contains a corticosteroid and a "short-acting" bronchodilator. This is only used for quick relief of symptoms:

●Budesonide-albuterol (brand name: Airsupra)

How do I use a corticosteroid inhaler? — There are 2 different types of corticosteroid inhalers:

●Metered-dose inhalers – Most metered-dose inhalers spray medicine when you press down on the top of the canister (figure 1). Some are meant to be used with a spacer. A spacer is a device that attaches to the inhaler's mouthpiece. When you press down on the canister, the medicine sprays into the spacer and sits there until you breathe it in. Your doctor or nurse will tell you if you should use a spacer with your corticosteroid inhaler.

●Dry powder inhalers – These release medicine when you take a deep breath in from the inhaler. Different dry powder inhalers are available. Each comes with directions on how to use it.

Brand names of inhalers often include a word or abbreviation like "Digihaler," "Diskus," "Ellipta," "Flexhaler," "HFA," or "RespiClick." This refers to the shape or style of the inhaler device, not the medicine it contains.

Each type of inhaler is used in a different way. Your doctor, nurse, or pharmacist will show you how to use the inhaler prescribed for you. There are separate patient education articles in UpToDate that have more information about each type of inhaler. These are listed at the end of this article.

What are the side effects of inhaled corticosteroids? — Inhaled corticosteroids usually have no side effects or only mild side effects when you use them correctly. Common side effects are:

●Thrush – This is a fungal infection that causes soreness and white patches in the mouth.

●Hoarse voice

●Sore throat or mouth

To help prevent these side effects, gargle and rinse your mouth with water or mouthwash after you use your inhaler. If you do get thrush, your doctor can prescribe a medicine to treat it.

Some people who need very high doses of inhaled corticosteroids for a long time can have other side effects. These can include increased appetite, bruising, infections, thinning or weakening of the bones, and slowed growth in children.

What else should I know about inhaled corticosteroids? — These are some things to remember:

●Inhaled corticosteroids help prevent breathing problem flares. Most of them do not work to relieve symptoms quickly, like in an asthma or COPD "attack." If your inhaler does not work to relieve symptoms quickly, your doctor will prescribe a different kind of inhaler to help quickly relieve breathing problems.

●It’s important to use your steroid inhaler as your prescription says. For some people, that means using it every day, even if you feel well.

●Rinsing your mouth and gargling with water or mouthwash after using your inhaler helps prevent common side effects. This is especially important for people who use higher or more frequent doses.

●If you are not sure how to use your inhaler or spacer correctly, talk to your doctor, nurse, or pharmacist.

●If you are pregnant or want to get pregnant, talk with your doctor. Inhaled corticosteroids are safe to use during pregnancy and breastfeeding, but it's best to review this with your doctor first.

For more detailed information about your medicines, ask your doctor or nurse for information from Lexicomp available through UpToDate. The Lexicomp handouts explain how to use and store your medicines. They also list possible side effects and warn you if your medicines should not be taken with certain other medicines or foods.

More on this topic

Patient education: Asthma in adults (The Basics)
Patient education: Medicines for asthma (The Basics)
Patient education: Chronic obstructive pulmonary disease (COPD) (The Basics)
Patient education: Medicines for COPD (The Basics)
Patient education: How to use your metered dose inhaler (adults) (The Basics)
Patient education: How to use your dry powder inhaler (adults) (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Oral steroid medicines (The Basics)
Patient education: Topical corticosteroid medicines (The Basics)

Patient education: Asthma treatment in adolescents and adults (Beyond the Basics)
Patient education: Chronic obstructive pulmonary disease (COPD) treatments (Beyond the Basics)
Patient education: Inhaler techniques in adults (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)