As it has been established in recent years, bronchial asthma is a chronic inflammatory disease of the airways. Inflammatory cells and inflammatory mediators also play an important role in the numerous pathogenic mechanisms of chronic obstructive pulmonary disease (COPD for its acronym in English and slow-onset lung for its acronym in Chinese). Therefore, inhaled glucocorticoids (ICS) have become important drugs for the treatment of bronchial asthma and chronic obstructive pulmonary disease. However, clinical findings show that, to date, a considerable number of patients with asthma and chronic obstructive pulmonary disease in China do not apply hormones, especially ICS, in a standardized manner, resulting in ineffective control of the disease and recurrent acute exacerbations, which greatly affect the quality of life of patients. Among the patients who have applied ICS, there are also many irregular and inappropriate cases. Treatment of bronchial asthma misconceptions are revealed At present, there are dozens of drugs for the clinical treatment of bronchial asthma. According to their ability to inhibit allergic inflammation in the airways, they are divided into “control drugs” with anti-inflammatory effects and “relief drugs” that do not have anti-inflammatory effects but can relieve asthma symptoms. ICS is the first choice for the treatment of bronchial asthma because it can effectively suppress airway inflammation, reduce asthma symptoms, improve lung function, improve the quality of life of asthma patients, reduce acute asthma attacks, reduce the frequency of emergency room visits and hospitalization due to asthma attacks, and ultimately reduce asthma mortality. The drug of choice for the treatment of bronchial asthma is “control”. For patients whose asthma is not effectively controlled by daily inhalation of low doses of ICS, long-acting beta agonists may be combined or the dose of ICS may be increased as appropriate. Beta agonists (e.g., albuterol aerosol), anticholinergics (e.g., Advil aerosol), and aminophylline, which have no anti-inflammatory effect and can only temporarily relieve wheezing symptoms, are more commonly used to “relieve” asthma symptoms. It can be said that the long-term and correct use of ICS is the litmus test to determine whether the treatment of bronchial asthma is standardized. At present, a considerable number of bronchial asthma patients in China have not received standardized treatment. Myth 1: Anti-inflammatory therapy is not given or is inadequate Many clinicians and asthma patients are only satisfied with the temporary relief of cough and shortness of breath symptoms. ICS inhalation is not given, or the inhaled ICS dose is too small and the course of treatment is too short. Bronchial asthma is a chronic disease of the respiratory tract, and it takes at least 2 years or more to achieve and maintain asthma control. Otherwise the disease is prone to recurrence or the medication cannot be stopped, the key point is that the airway inflammation is still present. Myth 2: Too much concern about the adverse effects and safety of ICS Although there are no absolutely safe drugs, ICS is one of the safer drugs in clinical practice. It rarely causes systemic adverse reactions, but the main adverse reactions are local discomfort in the throat, hoarseness and mycobacterial infections. It also has a good safety profile for pregnant women. If you are afraid to inhale ICS for fear of its adverse effects, it will only lead to an acute asthma attack, which will result in having to use higher doses of systemic hormones to control the symptoms, which will cause more adverse effects and is more than worth the loss. This fear of hormones is more pronounced in young, beauty-conscious female patients. Clinicians should do a better job of communicating and educating their patients. Myth 3: Incorrect inhalation methods Different inhalation devices have different inhalation methods. Among them, it is very important to inhale slowly and forcefully and to hold the breath at the end of inhalation. If not done properly, it will significantly affect the dose of drugs inhaled into the lower respiratory tract and lungs, which will naturally affect the clinical efficacy. The author has also encountered bronchial asthma patients who complained of poor drug efficacy after 1~2 months of inhalation, when in fact the lid of the inhalation device was never even opened. It is evident that we clinicians should not be satisfied with just prescribing the correct medication to patients, but should teach them the correct way to use the inhalation device, and, in the follow-up visits, should repeatedly check whether the patients inhaled the medication correctly. As mentioned above, although ICS does not have as many systemic adverse reactions as systemic (oral or intravenous) hormone use, a few patients may have to stop inhaling ICS because of severe local adverse reactions; therefore, it is very important to wash the residual drug in the throat promptly and adequately after inhaling ICS. Some patients think that swallowing the mouthwash can more or less exert the effect of inhaled hormone and can avoid wasting the medication. This is a misconception! Because, only the ICS inhaled into the lower respiratory tract can play the role of suppressing airway inflammation, the ICS adhered to the throat during inhalation not only has no role in treating asthma, but on the contrary, the hormone absorbed into the blood after swallowing into the gastrointestinal tract can increase the adverse reaction of hormone. Myth 5: Failure to regularly follow up and assess the level of asthma control of patients and adjust the treatment plan in time Like other chronic diseases, the prevention and treatment of bronchial asthma requires at least several years. Follow-up visits every 2-3 months are essential to assess the patient’s level of control in order to determine whether the current treatment plan is appropriate and whether to continue maintenance therapy, upgrade therapy, or downgrade therapy. There are many patients who are not followed up regularly, resulting in inadequate treatment or overtreatment, which affects the efficacy and safety. Misconceptions about application in slow-onset lung Almost all patients with asthma require inhaled ICS, except for mild asthma with intermittent attacks. slow-onset lung requires lifelong use of ICS, which is different from bronchial asthma. ICS is currently recommended as a first-line agent for the treatment of moderate-to-severe chronic obstructive pulmonary disease in international initiatives for the prevention and treatment of chronic obstructive pulmonary disease. ICS is often combined with a long-acting beta agonist (LABA) and/or a long-acting anticholinergic (LAMA). The results of several randomized, double-blind, multicenter clinical trials have shown that the combination of ICS and LABA, ICS and LAMA, or simultaneous inhalation of ICS, LABA, and LAMA is effective in treating slow-onset lung, helping to reduce acute exacerbations of slow-onset lung, improve lung function, improve quality of life, and even reduce mortality. In addition to the five major problems mentioned above, there are also some other misconceptions about the use of ICS for the treatment of chronic obstructive pulmonary disease. The hope is that the dose can be reduced or discontinued as in the case of bronchial asthma Although chronic airway inflammation is present in both chronic obstructive pulmonary disease and asthma, there are differences in the types of inflammatory cells and inflammatory mediators. Overall, the prognosis of bronchial asthma is better than that of slow-onset obstructive pulmonary disease. There are now clearer targets for dose reduction, and even discontinuation, for bronchial asthma, whereas the course of ICS use in patients with chronic obstructive pulmonary disease is essentially lifelong. One-sided perception of increased risk of lung infection in patients with chronic obstructive pulmonary disease ①. It is believed that ICS treatment for chronic obstructive pulmonary disease does not increase the chance of lung infection. In fact, the results of large clinical studies, including TORCH, have confirmed that ICS treatment for chronic obstructive pulmonary disease can significantly increase the risk of lung infection, only that the risk of fatal lung infection is not significantly increased. Therefore, we should pay attention to the safety of ICS treatment. (ii) It is believed that all ICS increase the chance of lung infections in patients with chronic obstructive pulmonary disease. The published results of the PATHOS study showed that while there is evidence that the ICS fluticasone has an increased risk of pulmonary infection in the treatment of chronic obstructive pulmonary disease, budesonide, another commonly used ICS, did not increase the risk of pulmonary infection in patients treated for chronic obstructive pulmonary disease. Perhaps this is related to the different molecular structures and pharmacological properties of the hormones.