Inhaled steroids: Many options to choose from

The following post was initially posted at healthcentral.com/asthma under the heading: What inhaled steroid is best for my asthma?

Chances are if you have asthma you have some degree of chronic (it's always there) inflammation in your air passages.  Studies have proven the best and safest way of treating this inflammation is daily use of inhaled corticosteroids.

Inhaled corticosteroids are now a top line treatment for asthma proven to reduce inflammation in your lungs.  In this way, the medicine controls and prevents asthma.

There are a lot of inhaled corticosteroids on the market, so the trick is to find the one that works best for your asthma.

Basically, how much inflamation is present in your lungs determines how severe your asthma is.  A little inflammation may be easily treatable with just your basic inhaled steroid -- like beclamethasone.

Yet if you have a great deal of inflammation a basic inhaled steroid may not be enough, and you may require a stronger inhaled corticosteroid, or even a combination medicine like Advair to control your asthma.

The following is a list of all the inhaled corticosteroids followed by my professional and personal advice (experience) using that product.  Here we go:

Basic Inhaled Steroids:

Beclomethasone (Vanceril, Beclovent, Qvar):  This was the first inhaled steroid to hit the market in the 1960s.  It was almost written off until a report was released in 1971 showing it's effectiveness for treating asthma.  I was on this medicine during the 70s and 80s.  It's the least expensive, so if it works that's great.  Yet if your asthma continues to act up, there are far better inhaled steroids on the market.

Note:  Some studies might renew interest in medicine due to studies showing QVAR is smaller and gets deeper into the lungs for more equal distribution of the medicine.  Whether these studies will amount to anything is yet to be seen, although some suggest this medicine may prove useful for hardluck asthma.  You can read more here.

Flunisolide (Aerobid):  Good inhaled steroid but tastes like rotton mints.  I took one puff of this inhaler about 20 years ago and tossed in the trash.  It's one of the medicines phased out when CFC inhalers lost favor.

Mometasone furoate (Asmanex):  It's a once a day medicine, or twice a day if need be.  I've never experienced it so I'll leave this space open for you guys to fill in.

Triamcinolone (Azmacort):  It's was a good inhaled steroid in it's day, but you had to take four puffs four times a day to equal the potency of Flovent.  This made compliance a problem.  It's the inhaled steroid I used from 1985 to 1998.  It tasted good (if that's possible for an inhaler), yet never as effective as modern medicines.  This probably weighted into the decision to stop manufacture of it.

Fluticasone propronate (Flovent):  A very good inhaled steroid.  The nice thing about Flovent is two puffs twice a day is far better than four puffs four times a day.  It makes for better compliance.  It's potent and safe.  I recommend it.  If it doesn't work try Advair.  My asthma greatly improved when I switch to flovent in 1998.  I was on this medicine until I was introduced to Advair in 2004.

Budesonide (Pulmicort):  It's the only inhaled steroid available as a solution, and for that reason it's mainly prescribed for kids and adults who can't use an inhaler.  From what I can tell it has the same potency as Flovent. 

Combination inhalers:  If an inhaled corticosteroid alone is not working, then you may need one of these inhalers.  Which one works best may be simply a matter of personal preference.

Note:  Be careful not to let all the warnings about these medicine scare you.  I give combination medicines all the credit for greatly improving my asthma.  It amazes me all the stories I hear from fellow asthmatics who could never gain control of their asthma until they tried one.  Yet there are also quite a few who continue to have hardluck asthma because they're afraid to try one.  I wrote more about this here.

Advair (Fluticasone + Salmeterol):  The original combination inhaler is still the most popular.   Basically it combines a steroid with a long acting beta adrenergic (LABA).  The steroid controls inflammation while the LABA keeps your lungs relaxed around the clock.  The combination of these medicines has worked wonders for many asthmatics. The best part of this medicine is all you need to do is take one puff in the morning and one before bed.  This greatly improves compliance, and that alone I think has benefited many asthmatics.

Symbicort (Budesonide + Formoterol):  This basically works the same as Advair except the LABA is faster acting and appears to have a stronger cardiac effect (on me anyway).  I know many asthmatics who love this medicine.  So, once again, personal preference reigns.  If one medicine doesn't work try another.

Note:  Some countries have adopted the Symbicort Smart program whereby you can use your Symbicort as a rescue inhaler.  I wrote about this here.

Dulera (Formoterol + Mometasone): It's the same inhaled steroid as Advair and the same LABA as Symbicort.  Since I think both these inhaled steroids work about the same, I consider this medicine to be the same as Symbicort.

Conclusion:  Whichever one of these medicines you try, don't give up on it.  It generally takes two to three weeks for the medicine to get into your system.  Likewise, it took me two to three months simply to wean myself onto my combination inhaler.  So be sure to be patient, give the medicine a chance to work, and work with your doctor.

Likewise, you will also want to make sure you take this medicine every day even when you feel well -- especially when you feel well.  This way the medicine stays in your system, your airway inflammation is always controlled, and your asthma stays in check.