Clinical Pharmacology of Corticosteroids
Abstract
Corticosteroids have numerous applications in treating inflammation and diseases of immune function based on their significant anti-inflammatory and immunosuppressive effects. Corticosteroids modulate immune function through various effects in the nucleus of numerous cells. When used in pharmacologic doses to suppress allergic responses or inflammation, these agents can cause numerous adverse effects associated with an excess of glucocorticoid activity. Prolonged use (>2 wk) results in suppression of the hypothalamic-pituitary-adrenal axis, which requires tapering of doses. Dosing strategies for systemic corticosteroids are designed to minimize the risk for hypothalamic-pituitary-adrenal axis suppression. Topical administration of corticosteroids, including oral inhalation, is often used to avoid the significant adverse effects associated with chronic use. Inhaled corticosteroids are potent synthetic agents that exert their actions locally in the airways but can cause systemic effects based on several factors that influence systemic bioavailability. Inhaled corticosteroids are the cornerstone of asthma therapy and important options for COPD in patients who experience frequent exacerbations. By the nasal route, they are the most effective therapy for treating moderate-to-severe allergic rhinitis.
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GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION
PAUWELS, R. A. (1996) · Arerugī/Arerugi · doi:10.15036/arerugi.45.792 · Cited by 9,997 · see citing works
Global Initiative for Chronic Obstructive Lung Disease
Gerald, L. B., & Bailey, W. C. (2002) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200207000-00004 · Cited by 5,824 · see citing works
Liu, D., Ahmet, A., Ward, L., Krishnamoorthy, P., Mandelcorn, E. D., Leigh, R., Brown, J. P., Cohen, A., & Kim, H. (2013) · Allergy, Asthma & Clinical Immunology · doi:10.1186/1710-1492-9-30 · Cited by 1,268 · see citing works
Effect of Systemic Glucocorticoids on Exacerbations of Chronic Obstructive Pulmonary Disease
Niewoehner, D. E., Erbland, M. L., Deupree, R. H., Collins, D. E., Gross, N. J., Light, R. W., ANDERSON, P. J., & Morgan, N. A. (1999) · New England Journal of Medicine · doi:10.1056/nejm199906243402502 · Cited by 872 · see citing works
Waljee, A. K., Rogers, M. A. M., Lin, P., Singal, A. G., Stein, J. D., Marks, R. M., Ayanian, J. Z., & Nallamothu, B. K. (2017) · BMJ · doi:10.1136/bmj.j1415 · Cited by 830 · see citing works
Inhaled corticosteroids in COPD and the risk of serious pneumonia
Suissa, S., Patenaude, V., Lapi, F., & Ernst, P. (2013) · Thorax · doi:10.1136/thoraxjnl-2012-202872 · Cited by 440 · see citing works
Leuppi, J. D., Schüetz, P., Bingisser, R. M., Bodmer, M., Briel, M., Drescher, T., Duerring, U., Henzen, C., Leibbrandt, Y., Maier, S., et al. (2013) · JAMA · doi:10.1001/jama.2013.5023 · Cited by 425 · see citing works
Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease
Kew, K. M., & Seniukovich, A. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010115.pub2 · Cited by 395 · see citing works
Thorsson, L., Edsbäcker, S., & Conradson, T. (1994) · European Respiratory Journal · doi:10.1183/09031936.94.07101839 · Cited by 392 · see citing works
How Do Corticosteroids Work in Asthma?
Barnes, P. J., & Adcock, I. M. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-139-5_part_1-200309020-00012 · Cited by 371 · see citing works
Effect of Inhaled Glucocorticoids in Childhood on Adult Height
Kelly, H. W., Sternberg, A. L., Lescher, R., Fuhlbrigge, A. L., Williams, P. V., Zeiger, R. S., Raissy, H., Natta, M. L. V., Tonascia, J. A., & Strunk, R. C. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1203229 · Cited by 369 · see citing works
Genomewide Association between GLCCI1 and Response to Glucocorticoid Therapy in Asthma
Tantisira, K. G., Lasky-Su, J. A., Harada, M., Murphy, A., Litonjua, A. A., Himes, B. E., Lange, C., Lazarus, R. M., Sylvia, J. S., Klanderman, B. J., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa0911353 · Cited by 368 · see citing works
Outpatient Oral Prednisone after Emergency Treatment of Chronic Obstructive Pulmonary Disease
Aaron, S. D., Vandemheen, K. L., Hébert, P. C., Dales, R., Stiell, I. G., Ahuja, J., Dickinson, G. E., Brison, R. J., Rowe, B. H., Dreyer, J. F., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa023161 · Cited by 346 · see citing works
Tantisira, K. G., Lake, S. L., Silverman, E. S., Palmer, L. J., Lazarus, R. M., Silverman, E. K., Liggett, S. B., Gelfand, E. W., Rosenwasser, L. J., Richter, B. G., et al. (2004) · Human Molecular Genetics · doi:10.1093/hmg/ddh149 · Cited by 322 · see citing works
Inhaled corticosteroids: potency, dose equivalence and therapeutic index
Daley‐Yates, P. T. (2015) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.12637 · Cited by 260 · see citing works
Systemic Effect Comparisons of Six Inhaled Corticosteroid Preparations
Martin, R. J., Szefler, S. J., Chinchilli, V. M., Kraft, M., DOLOVICH, M. B., Boushey, H. A., Cherniack, R. M., Craig, T., Drazen, J. M., Fagan, J. K., et al. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2105013 · Cited by 256 · see citing works
Basic and Clinical Pharmacology of Glucocorticosteroids
Becker, D. E. (2013) · Anesthesia Progress · doi:10.2344/0003-3006-60.1.25 · Cited by 243 · see citing works
Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma
Derendorf, H., Nave, R., Drollmann, A., Cerasoli, F., & Wurst, W. (2006) · European Respiratory Journal · doi:10.1183/09031936.00074905 · Cited by 242 · see citing works
Early use of inhaled corticosteroids in the emergency department treatment of acute asthma
Edmonds, M. L., Milan, S. J., Camargo, C. A., et al. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002308.pub2 · Cited by 224 · see citing works
Pharmacokinetics and pharmacodynamics of inhaled corticosteroids
Derendorf, H., Hochhaus, G., Meibohm, B., Möllmann, H., & Barth, J. (1998) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(98)70156-3 · Cited by 217 · see citing works
Nomenclature of steroids (Recommendations 1989)
Moss, G. P. (1989) · Pure and Applied Chemistry · doi:10.1351/pac198961101783 · Cited by 206 · see citing works
Swartz, S. L., & Dluhy, R. G. (1978) · Drugs · doi:10.2165/00003495-197816030-00006 · Cited by 200 · see citing works
Steroids: pharmacology, complications, and practice delivery issues.
Ericson-Neilsen, W., & Kaye, A. D. (2014) · PubMed · Cited by 171 · see citing works
Inhaled corticosteroids: benefits and risks.
Geddes, D. M. (1992) · Thorax · doi:10.1136/thx.47.6.404 · Cited by 160 · see citing works
A Double-blind, Randomized Clinical Trial of Methylprednisolone in Status Asthmaticus
Haskell, R. J. (1983) · Archives of Internal Medicine · doi:10.1001/archinte.1983.00350070040006 · Cited by 146 · see citing works
Burgt, J. A. V., Busse, W. W., Martin, R. J., et al. (2000) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2000.111582 · Cited by 145 · see citing works
Inhaled Corticosteroids in Lung Diseases
Raissy, H., Kelly, H. W., Harkins, M. S., & Szefler, S. J. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201210-1853pp · Cited by 129 · see citing works
Development of fluticasone propionate and comparison with other inhaled corticosteroids
Johnson, M. W. (1998) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(98)70155-1 · Cited by 128 · see citing works
Hawkins, G. A., Lazarus, R. M., Smith, R. S., Tantisira, K. G., Meyers, D. A., Peters, S. P., Weiss, S. T., & Bleecker, E. R. (2009) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2009.01.049 · Cited by 114 · see citing works
Corticosteroid therapy for acute asthma
Rowe, B. H., Edmonds, M. L., Spooner, C. H., Diner, B. M., & Camargo, C. A. (2004) · Respiratory Medicine · doi:10.1016/j.rmed.2003.11.016 · Cited by 104 · see citing works
Effects of Age and Disease Severity on Systemic Corticosteroid Responses in Asthma
Phipatanakul, W., Mauger, D. T., Sorkness, R. L., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201607-1453oc · Cited by 102 · see citing works
Comparison of Inhaled Corticosteroids: An Update
Kelly, H. W. (2009) · Annals of Pharmacotherapy · doi:10.1345/aph.1l546 · Cited by 101 · see citing works
Loke, Y. K., Blanco, P., Thavarajah, M., & Wilson, A. M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0133428 · Cited by 98 · see citing works
Applications of Steroid in Clinical Practice: A Review
Shaikh, S. I., Verma, H., Yadav, N., Jauhari, M., & Bullangowda, J. (2012) · ISRN Anesthesiology · doi:10.5402/2012/985495 · Cited by 94 · see citing works
Genome-wide Association Identifies the T Gene as a Novel Asthma Pharmacogenetic Locus
Tantisira, K. G., Damask, A., Szefler, S. J., Schuemann, B., Markezich, A. J., Lasky-Su, J. A., Klanderman, B. J., Sylvia, J. S., Wu, R., Martínez, F. D., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201111-2061oc · Cited by 94 · see citing works
Early use of inhaled corticosteroids in the emergency department treatment of acute asthma
Edmonds, M. L., Camargo, C. A., Pollack, C. V., et al. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002308 · Cited by 90 · see citing works
Corticosteroid physiology and principles of therapy
Gupta, P., & Bhatia, V. (2008) · The Indian Journal of Pediatrics · doi:10.1007/s12098-008-0208-1 · Cited by 84 · see citing works
(1989) · European Journal of Biochemistry · doi:10.1111/j.1432-1033.1989.tb15228.x · Cited by 84 · see citing works
A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma
Ye, Q., He, X.-O., & D’Urzo, A. D. (2017) · Pulmonary Therapy · doi:10.1007/s41030-017-0043-5 · Cited by 81 · see citing works
Interactions between corticosteroids and beta agonists
Taylor, D. R. (2000) · Thorax · doi:10.1136/thorax.55.7.595 · Cited by 79 · see citing works
Clinical pharmacology of corticosteroids in bronchial asthma
Lipworth, B. J. (1993) · Pharmacology & Therapeutics · doi:10.1016/0163-7258(93)90049-j · Cited by 75 · see citing works
Nelson, H. S., Busse, W. W., deBoisblanc, B. P., Berger, W. E., Noonan, M. J., Webb, D. R., Wolford, J. P., Mahajan, P. S., Hamedani, A. G., Shah, T. P., et al. (1999) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(99)70501-4 · Cited by 74 · see citing works
Saberi, P., Phengrasamy, T., & Nguyen, D. (2013) · HIV Medicine · doi:10.1111/hiv.12039 · Cited by 73 · see citing works
Dose response of inhaled corticosteroids on bronchial hyperresponsiveness: a meta-analysis
Currie, G. P., Fowler, S. J., & Lipworth, B. J. (2003) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)62140-0 · Cited by 68 · see citing works
Adrenal Insufficiency in Sepsis
Annane, D. (2008) · Current Pharmaceutical Design · doi:10.2174/138161208784980626 · Cited by 66 · see citing works
Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi‐cohort study
Qian, C. J., Coulombe, J., Suissa, S., et al. (2017) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.13295 · Cited by 58 · see citing works
Drug interactions between inhaled corticosteroids and enzymatic inhibitors
Daveluy, A., Raignoux, C., Miremont‐Salamé, G., Girodet, P., Moore, N. D., Haramburu, F., & Molimard, M. (2009) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-009-0653-4 · Cited by 48 · see citing works
Ciclesonide versus other inhaled corticosteroids for chronic asthma in children
Kramer, S. F., Rottier, B. L., Scholten, R. J. P. M., et al. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010352 · Cited by 42 · see citing works
Rague, J. M. (2017) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2017.06.019 · Cited by 42 · see citing works
Obstructive Lung Diseases in HIV: A Clinical Review and Identification of Key Future Research Needs
Drummond, M., Kunisaki, K. M., & Huang, L. (2016) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0036-1578801 · Cited by 41 · see citing works
Time course of action of two inhaled corticosteroids, fluticasone propionate and budesonide
Phillips, K. M. (2003) · Thorax · doi:10.1136/thx.2003.015297 · Cited by 39 · see citing works
Inhaled Corticosteroids in Asthma Management
Sobande, P. O., & Kercsmar, C. M. (2008) · Respiratory Care · doi:10.4187/respcare.08530625 · Cited by 36 · see citing works
Genomewide Association Between GLCCI1 and Response to Glucocorticoid Therapy in Asthma
Chipps, B. E. (2012) · PEDIATRICS · doi:10.1542/peds.2012-2183ppp · Cited by 35 · see citing works
Inhaled corticosteroids in chronic obstructive pulmonary disease: a pro–con perspective
Babu, K. S., Kastelik, J. A., & Morjaria, J. B. (2014) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.12334 · Cited by 30 · see citing works
Comparing Inhaled Corticosteroids
Colice, G. (2000) · Respiratory Care · doi:10.1177/002013240004500708 · Cited by 23 · see citing works
Yeo, S., Aggarwal, B., Shantakumar, S., et al. (2017) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2017.1361824 · Cited by 20 · see citing works
Bourbeau, J., Aaron, S. D., Barnes, N. C., et al. (2016) · Respiratory Medicine · doi:10.1016/j.rmed.2016.12.015 · Cited by 13 · see citing works
Effect of Inhaled Glucocorticoids in Childhood on Adult Height
Chipps, B. E. (2013) · PEDIATRICS · doi:10.1542/peds.2013-2294www · Cited by 11 · see citing works
Advances in inhaled corticosteroid pharmacology
Zitt, M. J. (2007) · Allergy and Asthma Proceedings · doi:10.2500/aap.2007.28.2989 · Cited by 9 · see citing works
García‐Arieta, A. (2011) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2011.04017.x · Cited by 5 · see citing works
van der Molen, T., & Kocks, J. W. H. (2014) · npj Primary Care Respiratory Medicine · doi:10.1038/npjpcrm.2014.13 · Cited by 5 · see citing works
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Lockett, J., Inder, W. J., & Clifton, V. L. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae008 · Cited by 135 · see citing works
Katz, A., Shulkin, A., Housni, A., Roy‐Fleming, A., Rabasa‐Lhoret, R., Yale, J., Tsoukas, M. A., Peters, T. M., & Brazeau, A. (2026) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.70465 · Cited by 3 · see citing works
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Sahebi, K., Foroozand, H., Bahmei, M., Taghizadeh, R., Zare, S., & Inaloo, S. (2025) · Heliyon · doi:10.1016/j.heliyon.2025.e41675 · Cited by 2 · see citing works
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- Authors
- Williams, D. M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Williams, Dennis M
- ORCID
- Williams, Dennis M
- Venue
- Respiratory Care
- Publisher
- SAGE Publications
- Published
- 2018-06-01
- Volume
- 63
- Issue
- 6
- Pages
- 655-670
- ISSN
- 0020-1324 (ISSN-L)
- OpenAlex
- W2804035619
- Cited by
- 460
- References
- 61
- Citations by year
- 2026: 42 · 2025: 81 · 2024: 93 · 2023: 82 · 2022: 72 · 2021: 58 · 2020: 23 · 2019: 7 · 2018: 1
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Respiratory Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- corticosteroids, glucocorticoids, anti-inflammatory activity, immunosuppression, hypothalamic-pituitary-adrenal axis suppression, dose tapering, adverse effects, topical corticosteroids, inhaled corticosteroids, systemic bioavailability, asthma, COPD exacerbations, allergic rhinitis, intranasal corticosteroids, allergic reactions
- MeSH terms
- Anti-Inflammatory Agents, Asthma, Glucocorticoids, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Pulmonary Disease, Chronic Obstructive
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