Current issues for establishing inhaled corticosteroids as the antiinflammatory agents of choice in asthma

Airway inflammation appears to be present even in the mildest of asthma, and inhaled corticosteroids now form the mainstay of asthma therapy. Inhaled corticosteroids largely avoid the adverse effects associated with oral steroids and are now recommended in newly detected disease. Inhaled corticosteroids reduce airway inflammation, airway hyperresponsiveness, and the symptoms of asthma and improve lung function, irrespective of the patient's age or asthma severity. Several different inhaled corticosteroids are available as therapeutic options for the treatment of asthma, and these include fluticasone propionate, beclomethasone dipropionate, and budesonide. The efficacy and safety of inhaled corticosteroids are compared in this article, and inhaled corticosteroid therapy is also compared with other therapies. Recently, there has been a consensus that the optimal use of inhaled corticosteroids for asthma management is using a "start high--go low" approach, and the reasons for this are discussed.