page206
angioedema)
have been reported rarely.
Other
side-
effects
that
have been reported very rarely include
paradoxical
bronchospasm,
anxiety,
depression,
sleep
disturbances, and behavioural changes including hyper-
activity,
irritability,
and aggression (particularly in chil-
dren);
skin
thinning
and
bruising
have
also
been
reported.
Candidiasis
The risk of oral candidiasis can be reduced
by using a spacer device with the corticosteroid inhaler;
rinsing the mouth with water (or cleaning a child’s teeth)
after inhalation of a dose may also be helpful. Antifungal
oral suspension or lozenges (section 12.3.2) can be used
to treat oral candidiasis without discontinuing therapy.
Oral
An acute attack of asthma should be treated with a
short
course of
an oral
corticosteroid starting with a
high dose,
see Management
of
Acute Asthma table,
p.
173.
Patients whose asthma has deteriorated rapidly
usually respond quickly to corticosteroids. The dose can
usually be stopped abruptly;
tapering is not
needed
provided that
the patient
receives an inhaled cortico-
steroid in an adequate dose (apart from those on main-
tenance oral
corticosteroid treatment
or
where oral
corticosteroids are required for 3 or more weeks);
see
also Withdrawal
of
Corticosteroids,
section 6.3.2.
In
patients who have needed several courses of oral corti-
costeroids and in whom the possibility of
a period on
maintenance corticosteroids is being considered, it may
be useful
to taper the corticosteroid dose gradually to
identify a threshold dose for asthma control. This should
only be done after other standard options for controlling
asthma
have
been
tried
(see
the
Management
of
Chronic Asthma table,
p.
172).
In chronic asthma,
when the response to other drugs
has been inadequate,
longer term administration of an
oral corticosteroid may be necessary; in such cases high
doses of an inhaled corticosteroid should be continued
to minimise oral corticosteroid requirements,
see Man-
agement of Chronic Asthma table,
p.
172.
Patients tak-
ing long-term oral corticosteroids for asthma can often
be transferred to an inhaled corticosteroid but
the
transfer
must
be slow,
with gradual
reduction in the
dose of the oral
corticosteroid,
and at a time when the
asthma is well controlled.
During an acute exacerbation of
chronic obstructive
pulmonary disease,
prednisolone 30 mg daily should
be given for
7–14 days;
treatment
can be stopped
abruptly.
Prolonged treatment
with oral
prednisolone
is
of
no benefit
and maintenance treatment
is
not
normally recommended.
An oral
corticosteroid should normally be taken as a
single dose in the morning to reduce the disturbance to
circadian cortisol
secretion.
Dosage should always be
titrated to the lowest
dose that
controls
symptoms.
Regular peak-flow measurements help to optimise the
dose.
Parenteral
For the use of hydrocortisone injection in
the emergency treatment of
acute severe asthma,
see
Management of Acute Asthma table,
p.
173.
BECLOMETASONE DIPROPIONATE
(Beclomethasone Dipropionate)
Indications
prophylaxis of asthma (see also Manage-
ment of Chronic Asthma, p.
172)
Cautions
see notes above
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above
Dose
. By aerosol inhalation,
see Management of Chronic
Asthma, p.
172 (important: for
Clenil Modulite
c
and
Qvar
c
,
see under preparations)
. By inhalation of dry powder (important: for
Asmabec
c
and
Becodisks
c
,
see under preparations),
200–400 micrograms twice daily; adjusted as neces-
sary up to 800 micrograms twice daily;
CHILD
over 5
years 100–200 micrograms twice daily,
adjusted as
necessary
Beclometasone
(Non-proprietary) A
Dry powder for inhalation
,
beclometasone
dipropionate 100 micrograms/metered inhalation, net
price 100-dose unit = £5.36;
200 micrograms/
metered inhalation,
100-dose unit = £9.89,
200-dose
unit = £14.93;
400 micrograms/metered inhalation,
100-dose unit = £19.61.
Label: 8, counselling,
admin-
istration;
also 10 and steroid card with high doses
Brands include
Pulvinal
c
Beclometasone Dipropionate
,
Easy-
haler
c
Beclometasone Dipropionate
Inhalation powder, hard capsule
(for use with
Cyclohaler
c
device),
beclometasone dipropionate
100 micrograms,
net price 120-cap pack = £15.99;
200 micrograms,
120-cap pack = £25.00;
400 micr-
ograms, 120-cap pack = £32.25. Label: 8, counselling,
administration;
also 10 and steroid card with high
doses
Brands include
Beclometasone Cyclocaps
c
Asmabec Clickhaler
c
(UCB Pharma) A
Dry powder for inhalation
,
beclometasone
dipropionate 50 micrograms/metered inhalation,
net
price 200-dose unit = £6.42;
100 micrograms/
metered inhalation,
200-dose unit = £9.43;
250 micr-
ograms/metered inhalation,
100-dose unit = £11.83.
Label:
8,
counselling,
administration;
also 10 and
steroid card with high doses
Dose
by inhalation of powder,
prophylaxis of asthma,
100–
400 micrograms twice daily,
adjusted as necessary;
max.
1 mg
twice daily;
CHILD 6–12 years 50–200 micrograms twice daily,
adjusted as necessary
Becodisks
c
(A&H) A
Dry powder for inhalation
, disks containing 8 blisters
of beclometasone dipropionate 100 micrograms/blis-
ter,
net price 15 disks with
Diskhaler
c
device =
£11.30,
15-disk refill = £10.76;
200 micrograms/
blister, 15 disks with
Diskhaler
c
device = £21.54, 15-
disk refill = £20.99;
400 micrograms/blister,
15 disks
with
Diskhaler
c
device = £42.52,
15-disk refill =
£41.98.
Label:
8,
counselling,
administration;
also 10
and steroid card with high doses
Dose
by inhalation of powder, prophylaxis of asthma,
400 micr-
ograms twice daily,
adjusted as necessary to 800 micrograms
twice daily;
CHILD 5–12 years 100–200 micrograms twice daily,
adjusted as necessary
Clenil Modulite
c
(Chiesi) A
Aerosol inhalation
,
beclometasone dipropionate
50 micrograms/metered inhalation,
net price 200-
dose unit = £3.70;
100 micrograms/metered inhala-
tion = £7.42;
200 micrograms/metered inhalation =
£16.17; 250 micrograms/metered inhalation = £16.29.
186
3.2 Corticosteroids
BNF 61
3
Respiratory system