Inhaled steroids: Are they all created equal?

New inhaled steroids or new formulations of inhaled steroids continue to be introduced on a regular basis in an attempt to replace hydrochlorofluorocarbon propellant-based, pressurized, metered. dose delivery systems. New delivery systems are being introduced with either a replacement propellant in a pressurized metered dose inhaler, such as a hydrofluoroalkane, or a dry powder, breath-actuated delivery device. Although there are now many different steroid preparations and delivery devices available, little is known about their relative beneficial and adverse effects. Several recent studies have introduced methods to determine the comparative efficacy of different inhaled steroids as related to a standardized measure of systemic effect. Physicians should be familiar with the differences among the available choices of inhaled steroid-delivery device combinations in order to select therapy that will optimize response and minimize the risk for adverse effects.