Factors Influencing the Responsiveness to Inhaled Glucocorticoids of Patients With Moderate-to-Severe Asthma: Introdaction
Inhaled glucocorticoids (GCs) have revolutionized the treatment of asthma and have become the mainstay of therapy for patients with chronic asthma.
Physiology, airway inflammation, and airway remodeling in asthma patients are interrelated and improved with GC therapy. Early and long-term intervention with GC therapy is needed, even in patients with relatively mild asthma. According to asthma management guidelines, patients with moderate persistent asthma should begin inhaled GC therapy with a dose of 400 to 800 ^g of budesonide or its equivalent; treatment at this dosage should continue for >3 months, which is the amount of time required to obtain maximal benefit from the inhaled steroid. The dosage of inhaled GCs may then be reduced according to a simple step-down regimen, In some patients, the initial dose of steroid may be too low, making it necessary to increase the dose. In patients with severe persistent asthma, a budesonide dosage of >800 ^g/d may be needed, or therapy with oral steroids may be required in order to obtain initial control of the asthma.