Overview

Corticosteroids (cortisone-like drugs such as prednisone) are very effective at easing irritation and inflammation in the upper respiratory tract (nose and lungs).

The problem with oral steroids, however, is that they come with a long list of side effects if they are used on a regular basis (cataracts, glaucoma, fluid retention, high blood pressure, muscle weakness, weakened bones, peptic ulcer, mood swings, etc.)

Inhaled corticosteroids are not supposed to be absorbed into the body as readily and cause such serious adverse reactions.

For this reason, preparations such as Azmacort, AeroBid, Beclovent, Vanceril, and Flovent have become very popular as a first-line treatment for asthma. By calming the irritation and inflammation that is thought to precipitate asthma, physicians hope to prevent attacks or lessen their severity.

Azmacort is prescribed for patients with bronchial asthma who require regular treatment with a corticosteroid.

It is inappropriate for people who only require occasional corticosteroid therapy or who can control their asthma symptoms without steroid-type medications such as bronchodilators (e.g., albuterol — Ventolin, Proventil, etc.).

Side Effects and Interactions

Yeast infections (Candida albicans) can occur within the mouth and throat. It is important to have regular exams to rule out such an infection.

Other side effects may include dry mouth and throat, coughing, irritation of the throat, wheezing, rash, and hoarseness.

Rinsing the mouth with water after inhalation might reduce the risk of hoarseness and dry mouth.

Swelling of the face may suggest systemic absorption of a corticosteroid and should be reported promptly to a physician.

Other signs of corticosteroid absorption include cataracts and glaucoma. Report any symptoms to your physician promptly.

Special Precautions

Corticosteroid inhalers are not supposed to be readily absorbed into the body.

Nevertheless, a study in the New England Journal of Medicine (July 3, 1997) revealed that when asthma patients inhaled beclomethasone (found in Vanceril and Beclovent) for long periods of time, they experienced a substantial increase in cataract formation.

An article in JAMA (March 5, 1997) noted that high doses of inhaled steroids (taken for more than three months) increased the risk for glaucoma.

This suggests that there can be absorption of corticosteroid medication into the body from asthma inhalers.

No one should ever stop corticosteroid medication without medical supervision!

Great care is required when patients are switched from oral corticosteroid medication to inhaled corticosteroid drugs such as Azmacort.

It may take many months for a patient's system to recover from oral treatment and an asthma aerosol cannot completely suffice in time of stress or during a serious asthma attack. In such situations a physician much be contacted immediately.

Corticosteroid asthma inhalers are of little use during an acute asthma attack as they cannot provide much relief when there are constricted airways.

In such situations, a bronchodilator may be more appropriate. If a bronchodilator does not provide prompt relief while medical supervision should be sought immediately.

Because there is evidence that corticosteroid medications such as Azmacort can be absorbed into the body from an aerosol inhaler, care must be taken not to overuse such medicine.

A physician should periodically check for signs of systemic absorption. They include reduced growth in children, fluid retention, cataracts, glaucoma, acne, menstrual changes, enlarged face, and suppression of the body's natural cortisol production.

People with a risk of glaucoma or cataracts should be periodically checked by an ophthalmologist.

If it becomes necessary to discontinue a corticosteroid inhaler such as Azmacort, the process should be very gradual, following guidelines established with oral corticosteroid treatment.

People exposed to chicken pox or measles should contact a physician immediately. If the immune system is impaired (through excess corticosteroid exposure) these infections could become very serious.

Anyone with TB, herpes infection of the eye, or an untreated bacterial, fungal, or viral infection must seek medical supervision before starting corticosteroid therapy. Great caution is required in such situations as steroids may make such conditions quite hazardous.

Cases of yeast infections (Candida albicans) can occur within the mouth or throat with repeated use of any corticosteroid inhaler. If such an infection arises it requires medical supervision and appropriate antifungal therapy.

The long-term effects of inhaled corticosteroids on mouth, throat, and lung tissue are unknown.

A woman who may become pregnant should talk with a physician before using any corticosteroid medication.

Taking the Medicine

The usual adult dose of Azmacort is two puffs, three or four times daily.

Never exceed 16 puffs per day. Once asthma symptoms are well controlled it may be possible to maintain adequate control by getting the prescribed dose twice daily.

Only your physician can determine the proper amount of Azmacort.

Children between 6 and 12 years of age are often prescribed one or two puffs, three or four times daily. They should not exceed 12 puffs per day.

Of course each patient may require special dosing instructions depending upon his or her medical condition. Only a physician can establish the proper regimen.

Inhaled corticosteroids do not relieve acute asthma attacks promptly the way bronchodilators do.

To be effective it is necessary to use a corticosteroid on a daily basis to relieve irritation and inflammation and calm twitchy lungs.

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  1. EJ
    Reply

    I was prescribed Flovent after I started needing my albuterol (rescue) inhaler daily. I have been using albuterol for attacks or preventatively for exercise-induced asthma for 15 years. In my mid-30’s, I had a respiratory infection and was needing relief (using my albuterol) sometimes as often as every hour (I was pregnant).
    I had been given samples of Flovent before, but now was actually prescribed it, 2 puffs 2x/day of the 110mcg inhaler. I was told that albuterol was detrimental to phosphorous absorption, I thought, but have seen potassium mentioned on this site, so maybe that’s what it was. What is the issue here- potassium or phosphorous? And what are the potential negative effects?
    I have found that 1 puff once per day of Flovent has controlled my asthma so well, I basically don’t need the albuterol ever. Is this reduced dose acceptable? Is it so small that I might just be experiencing a placebo effect? I did try going off of it last year, only to have problems a few weeks afterward- it was fall allergy season.
    PEOPLE’S PHARMACY RESPONSE: IF YOUR ASTHMA IS UNDER CONTROL, YOU’VE GOT THE RIGHT DOSE.

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