title: Updates on the use of inhaled corticosteroids in asthma.
abstract: OBJECTIVE
  The purpose of this review is to compare and contrast the newer inhaled corticosteroid (ICS) ciclesonide with older ICSs in terms of pharmacodynamic and pharmacokinetic properties and how these affect comparative efficacy. In addition, clinical dosing strategies for ICSs including as-needed use will be explored.
  
  
  RESULTS
  Ciclesonide has demonstrated similar efficacy to that of fluticasone propionate and mometasone furoate in equipotent doses with a potentially improved therapeutic index. Once-daily administration of ICSs is generally not as effective as twice-daily. Continuous administration of ICSs does not change the natural history of asthma in either children or adults. Long-term administration of medium dose ICSs does not increase the risk of cataracts or osteopenia in children and young adults. Studies of as-needed ICSs in mild persistent asthma in adults and children have demonstrated mixed results, with some showing equal efficacy to continuous therapy and others showing superiority of continuous therapy.
  
  
  CONCLUSIONS
  Ciclesonide provides a newer ICS with favorable pharmacokinetics that may improve the therapeutic index, but assessment of its systemic effects such as growth await further studies. Continuous administration of ICSs in low to medium dose over many years is well tolerated. The use of as-needed ICSs in patients with mild persistent asthma is promising as a potential step-down therapy but awaits further studies.
authors: Department of Family and Community Medicine, University of Nevada School of Medicine, Reno, Nevada, USA. drstoloff@sbcglobal.net
authors: Stuart W
authors: SW
authors: Stoloff
authors: H W
authors: HW
authors: Kelly
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000309:Adrenal Insufficiency / Q000139:chemically induced; D000328:Adult; D000336:Aerosols; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002386:Cataract / Q000139:chemically induced; D002648:Child; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D006130:Growth Disorders / Q000139:chemically induced; D006801:Humans; D007223:Infant; D009330:Nebulizers and Vaporizers; D010024:Osteoporosis / Q000139:chemically induced; D011208:Powders; D011282:Pregnenediones / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000336:Aerosols; D018927:Anti-Asthmatic Agents; D011208:Powders; D011282:Pregnenediones; C120481:ciclesonide