Advances in Therapy

, Volume 31, Issue 8, pp 803–816 | Cite as

Pharmacological Consequences of Inhaled Drug Delivery to Small Airways in the Treatment of Asthma



Small peripheral airways are an important target for the anti-inflammatory treatment of asthma. To make anti-inflammatory drugs (inhaled corticosteroids [ICS]) effectively reach small airways, they should be delivered using inhalation techniques containing high proportions of fine or super-fine particles. Higher proportions of fine particles are associated with higher systemic absorption of ICS leading to an increased risk of endogenous cortisol suppression. Ciclesonide, despite the highest proportion of fine and super-fine particle fractions, is the only ICS not associated with an increased risk of systemic adverse effects, including cortisol suppression. In contrary to ICS, bronchodilators should not be administered to peripheral airways. This does not improve their efficacy and may increase their risk of cardiotoxicity. Thus, from a pharmacological point of view and the theory of aerosols’ deposition, fixed combinations of ICS and long-acting beta agonists are always suboptimal. In many cases, the best solution may be to use fine-particle ciclesonide and a non-fine particle beta agonist administered from separate inhalers.


Asthma Bronchodilators Inhaled corticosteroids Pharmacology of aerosols Pulmonary deposition Small airways Systemic bioavailability of inhaled drugs 

Supplementary material

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Supplementary material 1 (PDF 193 kb)


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© Springer Healthcare 2014

Authors and Affiliations

  1. 1.Clinical Department of Allergic and Internal DiseasesMedical University of BiałystokBialystokPoland
  2. 2.Takeda PolskaWarsawPoland

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