Let's talk about corticosteroids now.
Now the inhaled corticosteroids are frequently used.
In my opinion, they are actually under utilized
than they should be used in almost all of our patients.
These drugs inhibit phospholipase A2
and inhibit COX-2 expression.
Now what this does, it reduces the inflammatory cytokines
including prostaglandins and leukotrienes.
The thickness of the respiratory mucosa is therefore reduced.
Now, these drugs do not have an effect on dilatation.
So, they are not going to dilate the lung tubes,
they are going to just reduce the inflammation
and thereby increase the respiratory lumen.
These are the agents that are commonly sold in North America
that are active in corticosteroid type function.
Now the most commonly used one that we see is Flovent
which is universally sold as an orange puffer.
Now previously, we did not use steroids routinely.
And this has changed over time.
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.
Patients with COPD do not respond as well to steroids
or to anti-inflammatories in general.
So that's something important to recognize.
In terms of toxicity, it's exceedingly rare.
It's hard to get a high enough dose of corticosteroid
to actually cause a systemic effect.
However, local effect like an oral candidiasis
can occur and in fact occurs fairly often in the elderly.
So it's important that our patients gargle
after each use of a corticosteroid.
If a patient is complaining of a sore throat
after you start them on an oral corticosteroid,
make sure you have a quick look and ensure that
they don't have oral thrush or oral candidiasis.