Ans. D. None of the above. (Ref. KDT 6th/224 - 227)KDT 6th/pg. 225........Currently, inhaled steroids are not considered necessary for patients with mild and episodic asthma. They are indicated when inhaled beta2 agnoists are required almost daily or the disease is not only episodic. Peak effect is after 4-7 days of instituting inhaled steroids. They have no role in acute attack of asthma or in status asthmaticus.# While inhaled steroids differ markedly in their affinities for the glucocorticoid receptor, with fluticasone and budesonide having much higher affinities than beclomethasone, they are all effective in controlling asthma at the appropriate doses. High dose inhaled steroid are beneficial only in advanced COPD with frequent exacerbations; should not be used in early/mild cases. Hoarseness of voice, dysphonia, sore throat, oropharyngeal candidiasis are the most common side effects. There is no e/o mucosal damage or increased incidence of chest infections even on prolonged use. Systemic effects mainly at doses > 600 microgm/dy. Inhaled steroid are safe during pregnancy.INHALED STEROIDS# Are glucocorticoids with high topical and low systemic activity.# There are currently five glucocorticoids available for inhalation therapy of asthma:- Beclomethasone dipropionate,- Triamcinolone acetonide,- Flunisolide,- Budesonide and- Fluticasone propionate.Inhaled steroids|||||FluticasoneBudesonide:Flunisolide:Ciclesonide:# High potency,# Longer duration,# No oral bioavailability.# High topicalrsystemic activity ratio.# Contraindicated in infections/nasal ulcers.# Used in prophylaxis & Rx of seasonal & perenial allergic or vasomotor rhinitis, & nasal polyposis.# Used in prophylaxis and Rx of seasonal and perennial rhinitis.# Prodrug# Cleaved by esterase in bronchial epith.# Uses noval approach to | topicahsystemic activity ratio.# Oral bioavailability <1%.# Extensivley bound to plasma proteins.