Pharmacological Management: Systemic Corticosteroids

Calvin Huynh, PharmD, and Elizabeth De la Riva-Velasco, MD

Introduction

•Systemic corticosteroids are a U.S. Food and Drug Administration– approved treatment for asthma exacerbations that are most effective when started early in an exacerbation.

•While childhood asthma leads all other medical causes for hospitalization, its treatment, including systemic corticosteroids, is essentially the same as that which would have prevented most hospitalizations had the treatment been administered earlier.

Mechanism of Action

•Asthma is characterized by hyperresponsiveness of the airways to various stimuli, which results in varying degrees of airway obstruction secondary to bronchospasm and inflammation.

•β₂-agonists do not alter the inflammatory component of airway obstruction.

•Anti-inflammatory therapy is essential to relieve airway obstruction that is subresponsive to bronchodilators.

•Corticosteroids block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation.

Indications and Administration