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Editorials |

The Dull-Edged Sword of Inhaled Corticosteroids

Susan M. Harding, MD, FCCP
Author and Funding Information

Affiliations: Birmingham, AL 
 ,  Associate Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham.

Correspondence to: Susan M. Harding, MD, FCCP, Associate Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT-Rm 215, Birmingham, AL 35294; e-mail: sharding@uab.edu



Chest. 1999;116(4):854-856. doi:10.1378/chest.116.4.854
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Extract

The pathobiology of asthma includes an inflammatory process, and asthma management with inhaled corticosteroids improves asthma control, pulmonary function, and quality of life, and decreases the number of asthma-related emergency room visits and hospitalizations.1 The administration of inhaled corticosteroids also reduces airway responsiveness with respect to methacholine challenge; prevents allergen-induced bronchoconstriction in atopic patients; and, when directly compared to leukotriene modifiers in patients with mild to moderate persistent asthma, results in a higher magnitude of improvement in FEV1.,12 At the cellular level, inhaled corticosteroids decrease the number and state of activation of eosinophils and lymphocytes, as evidenced in BAL and endobronchial biopsy specimens, and may alter epithelial basement membrane morphology in asthma patients. Inhaled corticosteroids have been used successfully for > 20 years, and their side-effect profile is favorable, especially when compared to the profile associated with oral corticosteroids.34 Inhaled corticosteroids are currently considered to be the foundation of asthma management.5 The advent of higher-dose inhaled corticosteroids has “freed” many asthma patients from oral corticosteroids; however, inhaled corticosteroids, especially in higher doses, can be partially absorbed and can cause systemic consequences.6 These potential systemic consequences are the dull-edged sword of inhaled corticosteroids.


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