Steroids such as corticosteroids are potent anti-inflammatory drugs that are used to treat conditions like acute inflammation and allergic reactions, though they can cause side effects like increased fat redistribution and risk of infection; other anti-inflammatory drugs include inhaled corticosteroids like beclomethasone and fluticasone to prevent airway inflammation, as well as leukotriene inhibitors and cromolyn sodium which are also used to prevent airway inflammation with fewer side effects than steroids.

1. Anti-Inflammatory Drugs
Steroids and NSAIDs
RC 195

2. Corticosteroids, “Steroids”
Naturally-occurring hormones produced by the adrenal glands
Glucocorticoids: Hydrocortisone
Mineralcorticoids: Aldosterone
Sex Hormones: Testosterone

3. Actions of Glucocorticoids
Anti-inflammatory
– Supresses actions of kinins, cytokines, and other mediators
of inflammation
• Maintains microcirculation and minimizes edema
• Maintains cell membrane integrity
• Inhibits macrophage movement
Inhibition of immune response
– Stabilizes mast cells
– Reduces histamine levels
Bronchodilation
– Potentiates catecholamine activity by inhibiting COMT and
increasing adenyl cyclase production
– Decreased cholinergic and alpha stimulation
– Decreased phosphodiesterase production

4. Steroid Uses
Acute Inflammation
Organ Transplant
Allergic Inflammation

5. Steroid Side Effects: “Cushing’s
Syndrome”
Gluconeogenesis
Osteoporosis Increased gastric acidity
Physical changes Decreased resistance to
– Increased fat production and infection
redistribution – MDI may cause candida
– Acne albicans, “thrush”
– Hirsutism – Patients need to rinse mouth
– Fragile skin after MDI
Sodium retention Dependency
– Fluid retention – Both physical and
– Potassium loss and metabolic psychological
alkalosis • Patients may need to be
weaned from steroid therapy

6. Interaction with other drugs
Increased breakdown in the presence of:
– Dilantin, barbiturates, certain tranquilizers, anti-
histamines, ephedrine
Decreased breakdown (and greater chance of
severe side effects) in the presence of some
antibiotics, eg erythromycin

7. Steroids in Respiratory Care
For prevention of inflammation – aerosol
For relief of inflammation: systemic

8. Hydrocortisone
Brand name(s): Solu-Cortef, Cortef
Given orally or IV
Not usually aerosolized because of side effects

9. Prednisone (Prednisolone)
Brand: Deltasone, Delta-Cortef
4X as potent as hydrocortisone
Given orally
– Side effects minimized if given every other day
– Patient’s usually need to be weaned from it

10. Methylprednisolone
Brand: Solu-Medrol
Oral or IV
– Often used to help relieve airway inflammation

11. Triamcinolone
Brands: Azmacort, Kenalog
MDI- to prevent airway inflammation

12. Dexamethasone
Brand: Decadron
Often nebulized for acute upper airway
inflammation
– What else is used with it?

13. Beclomethasone
Brands: Vanceril, Beclovent, Becotide
MDI– to prevent airway inflammation

14. Mometasone Furoate
Brand: Asmanex
DPI “Twisthaler” 220mcg per pff
Started as one puff per day in then evening and
may go as high two puffs BID

15. Flunisolide
Brand: AeroBid
MDI – to prevent airway inflammation
Usually effective when given only BID

16. Fluticasone
Brand: Flovent
MDI (similar to Flunisolide)
Fluticasone is also sold as a combo drug,
Advair, which contains fluticasone and
salmeterol
– Taken as a dry powder inhaler (DPI)

17. Budesonide
Brand: Pulmicort
MDI – to prevent airway inflammation
Seems to get best effects with minimal side
effects

18. NSAIDs
Drugs that prevent airway inflammation
but usually have less side effects than
steroids

19. Cromolyn Sodium
Brands: Intal, Aarane
Is a mast cell stabilizer so used to prevent airway
inflammation
– Does not relieve airway inflammation!
Often used as an alternative to aerosol steroids in
children
Administered via Spinhaler (DPI), MDI, nebulizer
– Usually needs to be administered Q.I.D.
– May take at least two weeks before any effects are seen

20. Nedocromil Sodium
Brand: Tilade
Similar to cromolyn sodium (used to prevent
airway inflammation)
MDI – usually only needed B.I.D.

21. NSAIDs: Leukotriene Inhibitors
(used to prevent airway inflammation)
Zafirlukast (Accolate)
– Taken as a pill B.I.D.
Zileuton (Zyflo)
– Taken as a pill Q.I.D.
Montelukast (Singulair)
– Taken as a pill just once a day

22. NSAIDs: Omalizumab (Xolair)
Genetically engineered recombinant humanized
monoclonal antibody
Binds to IgE and prevents it from attaching to
mast cells
Given sub-Q 1-2 times per month

23. Case Study Time!