Introduction
Glucocorticoids (cortisone) are, along with beta-2 sympathomimetics, the most important group of drugs in the treatment of chronic inflammatory lung diseases such as bronchial asthma or COPD (chronic obstructive pulmonary disease). Used as a respiratory spray or powder, they enter the lungs and bronchi directly. There, glucocorticoids control the development of inflammation of the lung mucosa. In the long term, they alleviate the overreactivity of the lung tissue and reduce the frequency of respiratory distress attacks (asthma attacks). However, inhaled glucocorticoids are not drugs for acute emergencies, but only successful as part of a longer-term therapy.
Effect
Inhaled glucocorticoids (cortisone, cortisol) act on the bronchial mucosa. There they inhibit the development of inflammation by suppressing the release of the body’s own substances that trigger an inflammatory reaction (see review article on cortisone). They also reduce swelling of the mucous membranes and the formation of tough mucus.
It is very important that the glucocorticoids are inhaled regularly; even in phases when no symptoms occur. The success of asthma therapy with glucocorticoids can be seen in the long term. Only if an inflammation of the bronchial mucosa is prevented in the long term will hypersensitivity and the probability of breathing difficulties improve. After one week at the latest, a significant improvement in the symptoms should be noticeable.
When do you need cortisone for asthma?
The asthma therapy is divided into 5 stages. From stage 2 onwards, cortisone sprays, i.e. inhaled corticosteroids (ICS) are used. In stage 2, the use of inhaled corticosteroids in low doses is recommended.
In stage 3, medium-dose ICS are recommended, from stage 4 on, medium to high-dose ICS are recommended. In stage 5, systemic – i.e. oral or intravenous – use of cortisone preparations may also be necessary. However, this is only very rarely the case. Cortisone does not act as an immediate remedy for asthma but has a long-term effect: it has an anti-inflammatory effect on the hyperreactive bronchial mucosa and thus counteracts the recurrent inflammatory reactions in the respiratory tract in the longer term. Inhaled corticosteroids are therefore not only taken when required but always permanently and regularly.
Long term therapy
The diagnosis of asthma is usually associated with long-term therapy, depending on its severity. Many patients are afraid of long-term use of cortisone preparations. However, modern drugs are available today which have drastically minimised the risk of side effects common to cortisone.
The use of glucocorticoids prescribed for asthma is almost exclusively by inhalation. Only in very severe cases or in extremely inflamed and mucusy bronchial tubes is treatment temporarily given in tablet form. By inhalation, the active substance reaches deep into the lungs. Modern glucocorticoids form a depot in the tissue there. This means that the active ingredient is distributed only slowly from the lungs to the rest of the body, reducing the risk of undesirable side effects.
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