Inhaled corticosteroids in the treatment of bronchial asthma: new answers to old problems

Inhaled steroids are the central pharmaceutical agents for the in-depth treatment of bronchial asthma. Diverse molecules are currently available that, though belonging to the same family, have different pharmacokinetic and pharmacodynamic properties. Each molecoie, thus, conforms to a greater or lesser extent to the ideal characteristics of this family, namely a high local efficacy accompanied by a tow systemic impact. Generally speaking, the new generation inhaled steroids respond better than earlier molecules to these requisites, characterized as they are by a good penetration into the lung, long retention time at the site of infection, low oral absorption and an efficient systemic elimination. It should however be noted that the local and systemic effects of inhaled steroids are mediated by the same receptors; hence the idea of an inhaled steroid with high local efficacy and without undesirable systemic effects does not today seem realistic. Precisely this aspect reveals how important it is today, even with the new generation molecules, to use the lowest dose of inhaled steroid capable of ensuring disease control.