High doses of inhaled glucocorticoids may decrease the formation of bone and increase the breakdown (resorption) of bone leading to weak bones and fractures. Very high doses may cause suppression of the body's ability to make its own natural glucocorticoid in the adrenal glands. It is possible that patients with suppression of their adrenal glands may need increased amounts of glucocorticoids by the oral or intravenous route during periods of high physical stress such as illnesses when increased amounts of glucocorticoids are needed by the body.
Studies with oral and intravenous dosing of radiolabeled ciclesonide have shown an incomplete extent of oral absorption (%). The oral bioavailability of both ciclesonide and the active metabolite is negligible (<% for ciclesonide, <1% for the metabolite). Based on a γ-scintigraphy experiment, lung deposition in healthy subjects is 52%. In line with this figure, the systemic bioavailability for the active metabolite is >50% by using the ciclesonide metered dose inhaler. As the oral bioavailability for the active metabolite is <1%, the swallowed portion of the inhaled ciclesonide does not contribute to systemic absorption.
Advair (Fluticasone + Salmeterol) : The original combination inhaler is still the most popular. Basically it combines a steroid with a long acting beta adrenergic (LABA). The steroid controls inflammation while the LABA keeps your lungs relaxed around the clock. The combination of these medicines has worked wonders for many asthmatics. The best part of this medicine is all you need to do is take one puff in the morning and one before bed. This greatly improves complaince, and that alone I think has benefited many asthmatics.