The Steroid Question
Now that I’ve written yet another disclaimer so you never, ever mistake my words for a doctor’s, nurse’s, or therapist’s, I’m finally tackling asthma treatment. This post will remain a static page you can access through the tab above.
Let’s talk steroids.
But first, let’s talk preventative medicine. Persistent asthma–that’s any case of asthma that generates weekly symptoms without treatment, even if the symptoms are mild and infrequent–usually motivates a doctor to prescribe maintenance meds. Flares are a whole lot easier to prevent than to treat because they can spiral out of control very fast. And spending all your time chasing down flares, worrying they’ll turn severe enough to require an ER visit, is no way to live.
Believe me, AG’s been there. It’s scary and it’s dangerous and the best part? It’s usually avoidable, since most asthma usually responds well to treatment.
Part of that treatment means avoiding asthma triggers, part of it can include taking antihistamines if allergies are the main trigger, part of it involves carrying a quick-relief inhaler, and part of it usually includes preventative inhaled steroids.
No parent likes the idea of giving steroids to children.
And I imagine no adult asthmatics like the thought of taking steroids, either. Who wouldn’t prefer good health without medication? But that’s just it — the idea of making my kid take steroids for asthma maintenance was far different from the reality of the benefits on her health and the real–as opposed to what I imagined–side effects.
Inhaled maintenance corticosteroids are NOT the same thing as anabolic steroids.
Let’s get that idea out of the way, too, because it formed a large portion of my mental block when AG was younger. Anabolic steroids are the ones you read about in the papers during pro-athlete scandals, the ones with horrible side effects like sterility, aggression, liver damage, masculinization of women, and even death. They are a synthetic version of the male sex hormone, and they work on protein and muscle.
Corticosteroids are synthetic versions of natural hormones that regulate things like the body’s stress and inflammation responses. Unlike anabolic steroids, these have nothing to do with sex and don’t affect the liver. The other difference here is that athletes who abuse anabolic steroids inject them or take them orally, and maintenance corticosteroids for asthma are inhaled directly into the lungs. (Except when severe flares warrant a oral dosage, but we’ll get to that.)
Inhaling the corticosteroids sends them directly to the bronchial and lung tissue where they need to go, and very little enters the bloodstream. So inhaled steroids don’t affect other organs to the extent that oral ones do.
But Why Steroids?
Remember how all asthma patients have swollen, inflamed airways and no one knows why? I always picture this part as a light switch when I’m thinking about my daughter. Somehow, her hyper-reactive switch got turned *on,* and there’s no way I can turn it *off.* Figuring out how to flip that switch would be the cure.
If I can’t turn the switch off, what I can do is beat down that bronchial inflammation that results. As I understand the process, inhaling corticosteroids can do this because that’s what the natural ones in her body do–they help balance out and regulate the healthy inflammatory response.
I think of it this way: if AG has problems with extra inflammation, then she needs extra amounts of the corticosteroids that reduce it. Bombarding the exact location–her airways–with a low level of steroids does the trick and minimizes the side effects. Then when she does encounter triggers, her flares aren’t made worse by swollen and irritated tissue.
Another reason why inhaled steroids aren’t as bad as they first sound? Doctors prescribe the lowest possible dose to maintain asthma control and can tailor the frequency of use for each patient. My daughter, for example, is lucky enough to use the lowest dosage (44 mcg) controller inhaler and doesn’t use it all during the summer.
What About the Side Effects?
Even inhaled corticosteroids have some, of course, but they’re minimal. The main one is throat irritation or thrush, which are avoidable by rinsing after using the inhaler. While not definitive, a few studies seem to indicate a slightly higher risk for cataracts in patients over 40 who use steroid inhalers and the risk of some bone loss in adults after long-term use.
Here’s the irony, though. Sometimes a parent (read: me) is terrified of inhaled corticosteroids without really knowing much about them, keeps her young child from using them despite moderate to severe persistent asthma not responding well to bronchodilators alone, and her kid (read: AG) ends up on oral corticosteroids instead. Those side effects are far, far more severe if used frequently because they enter the bloodstream.
Just about every asthma patient will end up needing a short burst of oral steroids to get over a particularly severe flare at least once, and these 5-day, infrequent courses mainly just result in a stomachache, weight gain from fluid, and mood swings. But using oral steroids often, like with severe asthma or with under-treated persistent asthma, can cause side effects from glaucoma and cataracts to osteoporosis and adrenal gland problems.
For me, the trade-off is clear. I can keep AG on daily inhaled steroids, or I can watch her flare constantly and end up on the more severe oral steroids several times every fall, winter, and spring. Because she will, no question.
Don’t be afraid of steroid inhalers if your child’s doctor prescribes one.
They don’t guarantee an existence free of life-threatening flares, but they sure can decrease the possibility. They changed my child’s life, and mine.
Common Inhaled Steroids
(Brand names in parentheses)
Beclomethasone (Beclovent, Qvar, Vanceril)
Flunisolide (Aerobid, Aerobid-M)
Mometasone furoate (Asmanex)
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