Ciclesonide

How it works

It is activated by esterases in the airways to its active metabolite, which binds glucocorticoid receptors to reduce airway inflammation while limiting systemic and oropharyngeal exposure.

Prescribing in practice

• It is a preventer for regular use and does not relieve acute bronchospasm, so a reliever inhaler remains necessary.
• As with all inhaled corticosteroids, sustained high exposure can produce systemic corticosteroid effects.
• Correct inhaler technique should be confirmed to ensure effective lung deposition.

Monitoring

Monitor asthma control, inhaler technique and, in children, growth during continued therapy.

Counselling the patient

• Use every day as a preventer, even when symptom-free.
• Keep a reliever inhaler for sudden breathlessness.
• Local airway activation means mouth thrush is less common, but rinsing remains good practice.

Evidence & guidelines

Inhaled corticosteroids including ciclesonide are supported as maintenance asthma therapy in national asthma guidance.