Intended for healthcare professionals


Inhaled corticosteroids for asthma: guidance is inconsistent

BMJ 2019; 367 doi: (Published 16 December 2019) Cite this as: BMJ 2019;367:l6934
  1. Duncan Keeley, general practitioner
  1. Thame, UK
  1. duncan.keeley{at}

Getting the dose right is critical for safe and effective symptom control

Inhaled corticosteroids have transformed the lives of people with asthma. Taken regularly they reduce or abolish symptoms and reduce the risk of exacerbations. For many people, low dose inhaled corticosteroids control symptoms without the need for regular bronchodilator treatment. Regular use of a bronchodilator suggests that the airway inflammation underlying the asthma symptoms has not been adequately controlled. At low doses, adverse effects from inhaled corticosteroids are minimal even when treatment is needed for many years. At higher doses there are small but significant risks of adverse effects.1

After obtaining good initial control, and with support from clinicians, patients can adjust the dose of inhaled steroid according to symptoms, stepping down if possible and aiming for good control with minimal requirement for bronchodilators. The various inhaled steroids differ in potency and dose range. But guidelines are inconsistent on dosing, particularly with respect to beclomethasone, …

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