Inhaled glucocorticoids is currently are the most effective method of prophylactic, subtree alive asthma therapy. Their application is based etsya on a strong local anti-inflammatory effect. Furthermore, when used for several months in patients with bronchial asthma, they reduce giperreaktivnost respiratory -negative pathways weakening spasmogenic effect of many biologists cally active substances (histamine, bradykinin, acetylcholine, adenosine), cold and damp air, carbon dioxide. Ingaly insulating glucocorticoids are considered as drugs you boron in patients with moderately-severe asthma, which, despite the increase in dose inhaled beta 2 adrenostimulyatorov, characterized by persistent degradation, presence eat uncontrolled symptoms decline of respiratory function.
For inhalation, beclomethasone, flunisolid, budesonide, triamcinolone acetonide and fluticasone are used. Their comparative characteristics are presented in table. 1
Inhaled corticosteroids should not be used for relief of an attack of asthma, as their effect develops slowly over a period of 1 week, and the maximum the action Wie celebrated after about 6 weeks of initiation of therapy.
Table 1
COMPARATIVE CHARACTERISTICS OF INHALATION Glucocorticoids
| A drug | Local activity | Systemic bioavailability | Plasma half-life (hour) |
| Beclomethasone | 500 | <5 | fifteen |
| Flunisolid | > 100 | twenty | 1,6 |
| Triamcinolone | 100 | There is no data | 2 |
| Bulesonide | 1000 | 10 | 2-2.8 |
| Fluticasone | 1000 | <1 | 17 |
Pharmacokinetics
When inhaled glucocorticoids only 10-20% reach the respiratory tract, whereas 80-90% DELAY alive in the mouth and then swallowed. After suction fi Niya in the gastrointestinal tract of a significant portion of the drug undergoes first-pass metabolism.
To increase the percentage of “getting” the drug into the bronchi, a spacer is used. It is a plastic re reservoir of narrowed portion of which is attached to the inhaler, and has extended the tip inserted into the mouth.
Adverse reactions
Systemic reactions. Inhaled glucocorticoids prac tically do not cause systemic adverse reactions Preece boiling oral preparation. Low systemic activity svya relates to their rapid inactivation in the liver and, partially, in the lungs. Only after prolonged use at high daily doses may inhibit the hypothalamic-pituitary-adrenal axis B STEM. In addition, the development of osteoporosis in women and growth retardation in children is possible.
Local adverse reactions are rare as great rule, as dysphonia and oropharyngeal candidiasis. Dysphonia due to myopathy of the muscles of the larynx is reversible and disappears when the drug is discontinued . Atrophic epithelium of the respiratory changes GOVERNMENTAL ways not observed even when using beclomethasone for 10 years.
Risk factors for candidiasis are the incorrect Noah inhaler use, advanced age, inhalation 2 times a day, the simultaneous use of antibiotics and / or corticosteroids inside. Preventive measures: the use of prep that before eating, rinse the mouth and throat after inhalation, the use of a spacer.
Intranasal administration of glucococorticoids is used to prevent and treat seasonal allergic rhinitis, as well as for recurrent polyposis of the nasal cavity and paranasal sinuses. Thanks to the powerful local antiinflammatory ef fect glucocorticoids attenuate symptoms such as runny nose, burning sensation in the nose, sneezing, nasal congestion. With very severe nasal congestion, local decongestants can be used within 3-5 days before use.
When administered intranasally glucocorticoids well ne carry over. Sometimes there may be a tingling sensation but in the Su or sneezing, in rare cases – hemorrhagic nasal discharge. These phenomena usually pass quickly and do not require discontinuation of the drug. In the application described budesonide development contact Nogo perinazalnogo atopic dermatitis.