Posted on: Saturday, May 8, 2004
PRESCRIPTIONS
Inhaled steroids crucial for asthma
By Landis Lum
Q.Both my son and I have asthma, and my doctor wants us to use a steroid inhaler every day, even when we're not wheezing. What gives? Not only does it not work as fast as quick-relief inhalers like Albuterol, Alupent, or Maxair, but aren't steroids bad?
If you or your child awakens three or more nights a month because of coughing or wheezing, or needs to use a quick-relief medication like albuterol inhaler three or more times a week, or requires albuterol prescriptions three or more times a year, then he qualifies under this "3 Strikes" rule for the use of daily inhaled steroids.
Why? He now has persistent asthma, and by adding inhaled steroids to his as-needed albuterol, he'll have less asthma symptoms, need fewer courses of high dose oral steroids (and actually reduce his total yearly steroid dose), have less doctor and emergency room visits, and have fewer hospitalizations.
Other drugs like Cromolyn (Intal), nedocromil (Tilade), theophylline, Foradil, Serevent, Accolate, and Singulair don't work as well as inhaled steroids like Qvar, Flovent, and Azmacort.
There are two reasons why narrowing of the airway — the cause of wheezing — occurs. One is spasm or contraction of the muscles in the airway wall. The second is thickening of the airway wall because of inflammation, which also increases sputum production.
Albuterol relaxes the muscles but won't reduce inflammation. Inhaled steroids will reduce airway inflammation, but takes a week to start to work, and 4 to 8 weeks for full relief of symptoms. You need both for maximum benefit.
These are not the same steroids body builders abuse. Recent studies offer reassurance that at usual doses, inhaled steroids do not significantly reduce eventual adult height. Untreated asthma results in a delay of puberty by about 1.3 years, which may explain the reduced growth seen in asthmatics. Inhaled steroids likewise have little effect on bone density, glaucoma, or cataracts.
If asthma awakens two or more nights a week, or daily symptoms occur, then add a third inhaler — a long acting so-called beta agonist like Serevent or Foradil. Spacer devices (ask a pharmacist or doctor about these) should be used to deliver inhaled drugs to kids. For those allergic to pets, dust mites, molds, cockroaches, etc., minimizing exposure and treating allergies will improve asthma. Treating hay fever, heartburn and sinus infections and avoiding cigarette smoke are crucial. l. And if your attack is not improving with home therapy, go to your clinic or the emergency room as soon as possible, even if it's 4 a.m. My patient died 10 years ago at age 30 because she delayed too long in getting to the emergency room.
This happens to be Asthma Awareness Month, and if you go to the Windward Mall today between 11 a.m.-2 p.m. or the Ward Warehouse second-floor (Kakaako ) conference room from 10 to 2, you'll be able to talk with asthma specialists and even test your lung function. Allergist Dr. Matthew Lau speaks on asthma at Windward Mall from 1:30 p.m.- 2 p.m.
Similar events will be held 12 to 4 on May 22 at the Kahala Mall and 12 to 4 on May 23 at the Windward Mall.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
