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Effectiveness and safety of inhaled steroids

This post presents more information on the effectiveness and safety of inhaled steroids.

This report is based on an analysis of the scientific evidence on inhaled steroids. Overall, 1,286 studies and research articles were screened. From these, the analysis focused on 78 studies and the following criteria:

■ Improvement in symptoms

■ Reduction in attacks

■ Reduction in the need for short-acting medications or oral steroids

■ Improvement in lung function

■ Improvement in quality of life

Overall, inhaled steroids work well in reducing asthma symptoms and preventing asthma attacks, based on these measures.

All six inhaled steroids have been compared to each other, and the evidence to date is not conclusive on whether any one is more or less effective than the others. Specifically, the drugs have been pitted against each other in 24 trials and one large overview of the literature, called a systematic review. Most of the studies found no differences in people taking one drug versus another.

Some studies found statistically significant differences for some of the above criteria. When there was a difference, fluticasone (Flovent) was usually found to be somewhat more effective. But in some of these studies, Flovent was given in a stronger dose.

There is less data available on the effectiveness of inhaled corticosteroids for COPD (chronic obstructive pulmonary (lung) disease). Some studies have been conducted with budesonide (Pulmicort) and fluticasone (Flovent) that show these drugs are useful.

In the studies that have been done in people with COPD, inhaled steroids have helped reduce sudden worsening of symptoms (called exacerbations), but only in people with moderate to severe chronic obstructive pulmonary disease. In people with the mild, early form of COPD, inhaled steroid treatment does not appear to slow progression of the disease or reduce sysmptoms.

Effectiveness and safety of inhaled steroids

Drug Interactions

Inhaled steroids are generally safe and have few known interactions with other drugs or dietary supplements. But even so, be sure to tell your doctor about all other medications you take.

Also, seniors with asthma need special attention. Some high blood pressure and glaucoma medications or aspirin can interfere with asthma drugs or possibly cause asthma attacks.

Age, Race, Gender, and Other Conditions

The effectiveness of inhaled steroids in treating asthma does not appear to differ based on age, gender, or race, or in patients who have other diseases.

Most of the studies conducted in people with chronic obstructive pulmonary (lung) disease have been in older patients. So their effect on COPD in younger people (under age 60) is unknown.

In five asthma studies in children and teens that compared inhaled steroids, the effectiveness was the same as in adults. There have been no studies in children younger than 6 months old. Most studies conducted in younger children – under age four – only compared budesonide to placebo, so there is little data on other inhaled steroids in young children. Budesonide is the only inhaled steroid that has been proven effective in children younger than five.

Inhaled steroids do present some risks during pregnancy, but the beneficial effects are believed to outweigh potential harms. Poorly controlled asthma during pregnancy has been associated with higher rates of premature birth, lower birth weight, and perinatal death. Proper use of inhaled steroids is thought to reduce the potential for these events.

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