The most-potent drugs for asthma, however, are steroids, or drugs in the cortisone family. Oral or injected steroids are usually prescribed only in cases of severe asthma, especially for those at risk for hospitalization or for patients who are already hospitalized. These drugs can be life-saving; in fact, one common feature of asthma mortality is the failure to take adequate doses of steroids. Unfortunately, systemic steroids have toxicity and therefore should not be used on a regular basis unless necessary.
Approximately 25 years ago, it was found that inhalation of steroid powder in a metered-dose inhaler had significant preventive action in the management of asthma. Initially, these inhaled steroids, of which beclomethasone was the prototype, were used only as secondary or tertiary agents. Asthma specialists now realize that these drugs are first-line agents and can often manage asthma by themselves. They are also important ancillaries to beta-agonists.
Unless used more frequently than recommended, aerosol steroids do not produce the negative side effects of oral or injected cortisone and can be quite effective. While they do not deliver the amount of cortisone required for severe (but unhospitalized) asthmatics, they are extremely helpful in subacute cases. These agents include Beclovent, Vanceril, Aerobid, Azmacort, Flovent, and Pulmicort. All of these agents have advantages and disadvantages over each other, but for the most part, patients end up using the inhaled steroids that are covered by their insurance carriers.
These drugs can be given as infrequently as twice a day and sometimes achieve a better result when a spacer is provided to help in the delivery of the inhaled dose. Pulmicort is also available as a turbuhaler, and Flovent is also available as a rotodisk. Both of these methods of delivery may be more comfortable and effective for some patients. Flovent, one of the newest of these agents, is available in three different concentrations and thus can be adjusted for patients of different ages and sizes. Aerobid is unpleasant to take because it has a bad taste and may induce nausea. I therefore do not recommend it, even in the mint flavor.
Use of low doses of inhaled steroids is hardly ever associated with systemic toxicity. However, long-term use of high doses can have adverse effects. The most common of these adverse effects are local complications, including coughing, horaseness, and an inflamed throat. In addition, patients who are receiving high doses of inhaled steroids should have ocular exams once a year to rule out the development of glaucoma.
One final point about inhaled steroids is that many patients also use a beta-agonist. In such a case, the patient should first use the beta-agonist, followed by the inhaled steroid. This regimen allows the airways to open, therefore allowing better penetration of the topical steroid. Inhaled steroids are to be used for prevention and should never be used to try to manage an asthma attack.
Approximately 25 years ago, it was found that inhalation of steroid powder in a metered-dose inhaler had significant preventive action in the management of asthma. Initially, these inhaled steroids, of which beclomethasone was the prototype, were used only as secondary or tertiary agents. Asthma specialists now realize that these drugs are first-line agents and can often manage asthma by themselves. They are also important ancillaries to beta-agonists.
Unless used more frequently than recommended, aerosol steroids do not produce the negative side effects of oral or injected cortisone and can be quite effective. While they do not deliver the amount of cortisone required for severe (but unhospitalized) asthmatics, they are extremely helpful in subacute cases. These agents include Beclovent, Vanceril, Aerobid, Azmacort, Flovent, and Pulmicort. All of these agents have advantages and disadvantages over each other, but for the most part, patients end up using the inhaled steroids that are covered by their insurance carriers.
These drugs can be given as infrequently as twice a day and sometimes achieve a better result when a spacer is provided to help in the delivery of the inhaled dose. Pulmicort is also available as a turbuhaler, and Flovent is also available as a rotodisk. Both of these methods of delivery may be more comfortable and effective for some patients. Flovent, one of the newest of these agents, is available in three different concentrations and thus can be adjusted for patients of different ages and sizes. Aerobid is unpleasant to take because it has a bad taste and may induce nausea. I therefore do not recommend it, even in the mint flavor.
Use of low doses of inhaled steroids is hardly ever associated with systemic toxicity. However, long-term use of high doses can have adverse effects. The most common of these adverse effects are local complications, including coughing, horaseness, and an inflamed throat. In addition, patients who are receiving high doses of inhaled steroids should have ocular exams once a year to rule out the development of glaucoma.
One final point about inhaled steroids is that many patients also use a beta-agonist. In such a case, the patient should first use the beta-agonist, followed by the inhaled steroid. This regimen allows the airways to open, therefore allowing better penetration of the topical steroid. Inhaled steroids are to be used for prevention and should never be used to try to manage an asthma attack.
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