Inhaled Steroids Question

I've gained the impression that there seems to be an upper daily limit on Inhaled Steroids around the 1000 Micrograms (mcg) level. However, when it comes to Oral Steroids - in pill form - both 'low' and 'average' daily dosages far exceed this, and are measured in Milligrams (mg's) with each Milligram being the equivalent of 1000mcg.

I'd like to know why there seems to be this restriction on Inhaled Steroids at 1000mcg when you can take a 'much higher' doses in pill form (i.e. 10, 20, 30 times that amount).

When I was FeNO Tested for a week (Fractional Inhaled Nitric Oxide) as part of the Test, my daily inhaled steroids were temporarily (for seven days) raised from 1000mcg to 2000mcg and, by the end of that week, my FeNO Score plummeted (by around 30%) to 48ppb (48 parts per billion) from 70ppb at the beginning of the week.

You may be aware that FeNO is one of the Tests used to gauge Lung Inflammation, the idea being that - the lower your FeNO Score - the less Inflammation is present. (Lower Lung Inflammation often translates to fewer respiratory symptoms).

So...if we can tolerate 'much higher' doses of Oral Steroids in Pill Form, why can't we Inhale higher doses of Steroids than the 1000mcg Ceiling that seems to be in place (or maybe we can, and I've just got this entirely wrong)?

Thanks in advance for any answer / reply you are able to provide.

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  • Here is a very comprehensive explanation:-

    pharmaceutical-journal.com/...

    You will only be allowed one access to this article!

    Another useful article from NZ:-

    medsafe.govt.nz/profs/PUart...

  • Thanks for that. Appreciated. Odd that stepping up the Inhaled Steroids beyond 800mcg are said to have little additional benefit (even though my one week increase to 2000mcg 'Inhaled' certainly seem to significantly benefit / reduce my FeNO Score). Also odd that the safety risk of more than 800mcg (inhaled) is implied to be higher than 10x the Dose taken in Pill Form. Still, 'things are as they is' I guess.

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