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Snapshot
  • A 25-year-old man presents to the clinic for complaints of "white patches" on his tongue for the past 2 weeks. He reports that the patches can be scraped off and does not bleed or cause pain. His medical history is significant for chronic asthma for which he was started on inhaled corticosteroids 3 weeks ago. 
Overview
  • One of 7 medications used for asthma aimed to reduce inflammation and obstruction 
    • corticosteroids 
    • β-agonists 
    • muscarinic antagonists 
    • methylxanthines 
    • cromolyn 
    • antileukotrienes 
    • omalizumab 
Inhaled Corticosteroids
  • Mechanism of action
    • inactivates NF-kB, the transcription factor that induces production of TNF-α and other inflammatory agents
      • subsequently inhibits the synthesis of most cytokines
      • examples
        • mometasone, fluticasone, budesonide, beclomethasone, triamcinolone, and flunisolide
  • Clinical use
    • chronic asthma
      • 1st line therapy   
    • chronic obstructive pulmonary disease (COPD)
  • Adverse effects
    • topical candidiasis/thrush
      • can be prevented with spacers or water rinse following usage of ICS  
    • dysphonia (e.g., hoarse voice)
    • lung infections (e.g., pneumonia)  
 

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