Wednesday, July 29, 2015

The unintended side-effects of inhaled steroids

When I was a kid their were fears among physicians that inhaled corticosteroids would have the same side effects as systemic corticosteroids. Based on this fear, I actually have discharge instructions by Dr. Gunderson at West Shore Hospital from 1981 that says to use Vanceril prn (as needed).

Since then, studies have proven that the inhaled route greatly reduces the side effects of any medicine, especially if the mouth is rinsed out after each puff. Studies also show that daily use (not prn use) greatly reduced inflammation in asthmatic airways allowing them to both prevent and control their asthma. So today, if you are prescribed an inhaled corticosteroid, it is pertinent that you inhale it every day exactly as prescribed.  The good news is that most of the newer inhalers only require one puff a day, making compliance easy.

Still, especially when higher doses are used, diffusion of the medicine may occur in the mouth, throat, and intestinal tract after swallowing, resulting in systemic side effects.  

Here are some of the potential systemic side effects: 
  1. Impaired growth in children
  2. Decreased bone mineral density
  3. Skin thinning and bruising
  4. Cataracts
  5. Decreased immune system response resulting in high risk for pneumonia
  6. Slow healing
It must be noted here that these potential risks are far less than the risk of suffering from and possibly even dying from uncontrolled asthma.  All of these side effects can be dealt with, and while they may cause some disability, none cause an early demise.

Now allow me to address the side effects of ICS on me.

1.  I am the shortest in my family, so it is possible that ICS did have an effect on my height. However, this has been an acceptable trade off, as I do not care how tall I am.  I further discuss this in another post if you want to read on.  

2.  I do not know how yet if ICS have had an impact on my bones.  By all data that I have access to, this has not been an issue up to this point.  We'll see how it goes as I become an old(er) man. 

3.  Skin thinning is not a problem.  Bruising is.  Man, when I get bumped I bruise very easy. I sometimes have bruises that last for months.  

4.  Cataracts I do not have.  Again, we'll see how this goes as I get older.

5.  I have at present not had pneumonia.  I also do not think that I have colds longer than anyone else, yet. 

6.  Slow healing.  This never really posed a problem until I separated my shoulder in the spring of 2013. That injury still hurts me to this day.  Likewise, I (while sober) fell out of bed during the winter of 2015, and that injury still plagues me.  My doctor said that these injuries usually heal fast, although age and a lifelong history of inhaled steroid use may inhibit or slow the healing process.  Thankfully these slow to heal injuries only plague me when I'm working out or playing sports.  Still, it is a "potential" systemic side effect.

Now, that said, if I could go back and revisit the inhaled steroid question would I do it all over again?  Well, considering that I have severe asthma that is controlled by these medicines, I would definitely do it again. Inhaled steroids have allowed me to live a normal life with asthma for over 30 years now.  So, in my case, the potential risks were well worth the potential side effects.

My advice: If you have moderate to severe asthma, inhaled corticosteroids is considered a top-line treatment for you.  If you're doctor prescribes them, please give them a try and take them as prescribed every day. You will soon find that you can live normal with this disease as I did.

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