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.

Dexamethasone in the era of COVID-19: friend or foe? An essay on the effects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes

“…Under non-stressed conditions, the human body produces approximately 20 mg of cortisol during the day. Situations of physical or psychological stress, such as infections, trauma or surgery, can result in a physiological increase in serum cortisol levels up to 150-200 mg [8,9]. In some circumstances associated with intense inflammation, such as sepsis, the adrenal gland's ability to produce cortisol may be insufficient to maintain vital function, a situation described as relative adrenal insufficiency [10].…”

The Impact of Corticosteroids on Mortality in Adult Patients with Septic Shock

“…Cortisol is the hormone that is important in fighting stressful events such as sepsis. The adrenal glands are incapable of generating enough cortisol in inflammatory states caused by serious diseases (Williams, 2018). This impairment in HPA axis cortisol production in the setting of sepsis may contribute to the body's difficulty in returning to a homeostatic state.…”

Mycobacterium tuberculosis–Specific Antigen Rv3619c Effectively Alleviates Allergic Asthma in Mice

“…The incidence of asthma has been increasing globally over the last few decades, with up to 339 million affected people worldwide (particularly children) (Kurvilla et al, 2019). Inhaled corticosteroids (ICS) remain the cornerstone of asthma therapy due to their demonstrated efficacy in reducing airway inflammation (Williams, 2018;Zhang et al, 2018). However, limitations associated with their use still exist (Olin and Wechsler, 2014).…”

“…However, limitations associated with their use still exist (Olin and Wechsler, 2014). For example, long-term usage can result in both local and systemic side effects and patients with severe asthma remain uncontrolled despite receiving high doses of inhaled steroids (Williams, 2018). The introduction of agents such as anti-IgE, anti-IL-4, and anti-IL-5 improved outcomes to a certain degree but more effective and affordable forms of treatment are still needed to deal with a global health challenge (Drick et al, 2018).…”