Glucocorticoids (or corticosteroids) are the most potent anti-inflammatory drugs and they have several modes of action. These include local anti-inflammatory effects that result from the inhibition of mediators of the arachidonic acid pathway in cells and by decreasing the influx of leukocytes into the local area. Corticosteroids indiscriminently enter cells and suppress pro-inflammatory factors and stimulate anti-inflammatory mediators. This leads to non-selectivity and a variety of serious adverse effects.
The inhaled steroids beclometason, budesonide, and fluticason are commonly used as first line treatment for the prophylaxis to reduce the chronic inflammation in asthmatic patients. Ciclesonide is another corticosteroid, but less applied because of less experience. Short pulses of systemic steroids are sometimes used to treat an acute exacerbation in an asthmatic patient. These short pulses should never exceed two weeks in order to avoid serious toxicities. If the respiratory patient requires chronic systemic steroids in order to reduce symptoms, the clinician should repeatedly try a slow taper to the lowest tolerated dose.
Corticosteroids inhibit all inflammatory activity
Extra info: Although potent anti-inflammatory agents, they are unable to inhbit all inflammatory activity (e.g. mast cell degranulation, etc).
All actions of corticosteroids are evoked by binding to the corticosteroid receptor.
Extra info: The cellular effects of the corticosteroids are mediated by the corticosteroid receptor, but the local effects such as inhibition of arachidonic acid and leukotriene chemotaxis are not.