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Steroid Phobia in Asthma More children have asthma now than ever before. The chances are good that either a child in your family has asthma, or you know a child who has asthma. No one really knows why there is so much more asthma now than there was 30 years ago. But one thing is clear: Asthma is a lot easier to treat than it was in previous generations. In the "bad old days" doctors didn’t have many medicines to prevent asthma attacks. The asthma medicines we did have didn’t work very well and caused many unpleasant side effects. The asthma medicines with the worst reputation were oral steroids. The bad reputation of steroids is well-deserved. Oral steroids taken for long periods of time cause excessive weight gain, bone loss, cataracts, high blood pressure, diabetes, and other harmful side effects. Children who take oral steroids for long periods often end up not growing as tall as expected. Because of these side effects, parents of asthmatic children often decided to stop giving the oral steroids. As a result, their children’s asthma would get worse. These children had attacks more often, and sometimes they ended up with permanent lung damage. Some would die from asthma. Children with asthma needed something better than oral steroids. And they got something better in the form of inhaled steroids. Asthma-controlling inhaled steroids today come in several forms: There are steroids that can be delivered by inhaler, either aerosol or dry-powder. There is even an asthma steroid that can be delivered by nebulizer. Inhaled steroids for prevention of asthma attacks have many advantages: Instead of exposing the entire body to the drug (including the parts that don’t need it) inhaled steroids go directly to the lungs. Because of this, the dose of inhaled steroid is a small fraction of the oral dose. Inhaled steroids for asthma work just as well as oral steroids. Best of all, inhaled steroids can be taken for long periods of time without harmful side effects. When inhaled steroids for asthma first appeared, many people worried that the side effects would be the same as those caused by oral steroids. Fortunately, numerous studies published in scientific and medical journals proved that inhaled steroids were safe. Inhaled steroids do not make children gain weight, and they don’t cause bone loss, high blood pressure, or diabetes. And inhaled steroids will not make an asthmatic child shorter than expected. In fact, children whose asthma is well-controlled with inhaled steroids grow better than they would if they weren’t taking inhaled steroids. The only side effect of inhaled steroids that I see is thrush, a yeast infection of the mouth that babies often get. This is usually mild and is relatively easy to treat. Even though inhaled steroids work well and are safe, I’m careful with them, just as I am with all medicines. For my patients with mild asthma, I don’t use steroids at all! For those patients who do need inhaled steroids, I start them on fairly hefty doses to get their asthma under control. Then I back off to the lowest dose that keeps the asthma symptoms from flaring up. Inhaled steroids often work better in combination with other, non-steroid asthma medicines. Adding a second or third medicine allows me to lower the inhaled steroid dose even further. Today, unlike 30 years ago, the great majority of children with asthma can do everything non-asthmatic children can do, including participate in sports at the highest levels. Despite the good news about inhaled steroids, there are many children who need them but aren’t taking them. If parents and pediatricians understood the great benefits and small risks of inhaled steroids, more children with asthma could live up to their potential. For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.
(508) 655-9699 Updated: |
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