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Inhaled corticosteroids (ICS) are the mainstay of “controller” therapy for asthma. Since asthma is a chronic inflammatory disorder of the airways, it makes sense to use steroids reduce the inflammation – these medications are used not just in treatment of asthma, but in other inflammatory diseases.
Long-Acting Beta Agonists (LABA) may be used in combination with ICS therapy based on response to the former (FACET trial, OPTIMA 1 / OPTIMA 2 clinical trials).
ICS comes in different formulations with different half-lives (T1/2) – and based on this requires it to be used usually once or twice a day. If it is not used as prescribed, it won’t work. Since ICS therapies are expensive, if you cannot use it as prescribed, review how you are using it to see if you should continue it.
Commonly used devices for ICS or LABA inhaled medications are “Dry Powder Inhalers” (DPIs) and “pressurized Metered Dose Inhalers” (pMDIs). Many factors are important in determining which type of device is best for you, including if you have dentures (the fit around the mouthpiece), arthritis of the hands (twisting) and neurologic issues that may affect how easy it is to coordinate the inhalation. pMDIs work best when used with a holding chamber, or spacer device – for optimal lower airway drug delivery. As well, properties of the drug and devices themselves is important, to consider how it is working for you.
Inhaled Medication – Drug Development
Since the 1950’s, the newer generation of inhaled medications have been developed in the “canisters” we commonly see being used, called pMDIs. These devices may look slightly different between specific drugs, however all have an amazing ability to take these medications deep down into the small airways. Checking inhaler technique frequently is important. Like other medications and inhalers brought into the Canadian market, they first need approval through Health Canada (https://www.canada.ca/en/health-canada.html) and it’s subsidiary branch CADTH (Canadian Agency for Drugs and Technologies in Health – https://www.cadth.ca/). Below is a list of commonly available inhaled medications (either ICS or combination inhalers) used in Canada listed in no particular order apart from availability in Canada. The list is not meant to be comprehensive or exhaustive, and does not replace your doctor’s advice. Additionally, review of inhaled medication characteristics with your pharmacist is always useful.
Common ICS in Canada:
Budesonide (Pulmicort®) – available in a turbuhaler device
Fluticasone (Flovent ®) – available in a discus or pMDI
Beclomethasone (QVAR®) – available in a pMDI
Ciclesonide (Alvesco®) – available in a pMDI
Mometasone (Asmanex®) – available in a twisthaler
Common ICS-LABA in Canada:
Budesonide-Formoterol (Symbicort®) – available in a turbuhaler
Fluticasone-Salmeterol (Advair®) – available in a discus or pMDI
Mometasone-Formoterol (Zenhale®) – available in a pMDI
Other Classes – other inhaled medications are available including long-acting muscarinic agonists (LAMA) – otherwise known as anticholinergic agents. As well, other classes of inhaled medications are available to treat respiratory symptoms related to asthma including Short-Acting Beta-Agonists (SABA) and Short-Acting Muscarinic Agonists (SAMA).
Drug Shortages – drug shortages in Canada have recently become an issue, including access to inhaled medications (www.drugshortagescanada.ca). Check in periodically with this website if you are having trouble getting your drugs dispensed through your pharmacy.