Corticosteroids

00:01 Let's talk about corticosteroids now. Now the inhaled corticosteroids are frequently used.

00:06 In my opinion, they are actually under utilized than they should be used in almost all of our patients.

00:12 These drugs inhibit phospholipase A2 and inhibit COX-2 expression.

00:19 Now what this does, it reduces the inflammatory cytokines including prostaglandins and leukotrienes.

00:26 The thickness of the respiratory mucosa is therefore reduced. Now, these drugs do not have an effect on dilatation.

00:35 So, they are not going to dilate the lung tubes, they are going to just reduce the inflammation and thereby increase the respiratory lumen.

00:47 These are the agents that are commonly sold in North America that are active in corticosteroid type function.

00:56 Now the most commonly used one that we see is Flovent which is universally sold as an orange puffer.

01:04 Now previously, we did not use steroids routinely. And this has changed over time.

01:10 We are starting to use them more and more in combination with beta agonists, and in fact we are starting to put both the corticosteroids and the beta agonists in one puffer.

01:21 Patients with COPD do not respond as well to steroids or to anti-inflammatories in general.

01:28 So that's something important to recognize.

01:31 In terms of toxicity, it's exceedingly rare.

01:33 It's hard to get a high enough dose of corticosteroid to actually cause a systemic effect.

01:39 However, local effect like an oral candidiasis can occur and in fact occurs fairly often in the elderly.

01:45 So it's important that our patients gargle after each use of a corticosteroid.

01:51 If a patient is complaining of a sore throat after you start them on an inhaled corticosteroid, make sure you have a quick look and ensure that they don't have oral thrush or oral candidiasis.