FCAAIA Notes: This is one of many studies showing the safety of inhaled steroids. Inhaled steroids have always been the first choice for persistent asthma. Their safety and negligible risk for side effects far outweighs the risks of poorly controlled asthma. In fact, this study also shows that oral steroids (the treatment of choice for significant asthma flares) are a risk factor for fracture.
The most common concern we hear about inhaled steroids is growth suppression in pre- and early adolescents. In fact, even those data are so weak that they are only a concern in those (extraordinarily rare) patients who already had significant growth suppression while on the medications. Those same studies usually fail to report that poorly controlled asthma with or without oral steroid bursts can also suppress growth rates. Continue reading “ASSOCIATION BETWEEN INHALED CORTICOSTEROID USE AND BONE FRACTURE IN CHILDREN WITH ASTHMA”
FCAAIA Notes: Pregnant or not, not too many people want to take medications they don’t need. But you always need to consider the risks of the disease as compared to those of the treatment.
The safety profile of medications for asthma (especially inhaled ones) is extraordinary, recognizing that nothing is 100%. But the risks of poorly controlled asthma in pregnancy are also extraordinary. As a result, our guidelines and tenets of for the care of pregnant women with asthma have not changed much over the last 20+ years. Continue reading “ASTHMA DURING PREGNANCY: EXACERBATIONS, MANAGEMENT, AND HEALTH OUTCOMES FOR MOTHER AND INFANT”
FCAAIA Notes: I have posted a lot of articles about vitamin D. Here’s another one.
As has been pointed out before, vitamin D is likely one of numerous contributing factors for asthma control. Most of your vitamin D is produced in the skin with sun exposure. Unfortunately, sun screens (while necessary) also decrease vitamin D production in the skin. It is hard but not impossible to get sufficient vitamin D levels (≥ 30 ng/dl) only by diet.
Vitamin D supplements may help some people. Continue reading “VITAMIN D MAY PROTECT AGAINST ASTHMA EXACERBATIONS”
FCAAIA Notes: Aspirin and medications related to it are collectively called nonsteroidal anti-inflammatory drugs (NSAIDs). As described in this article, a few different kinds of adverse reactions can occur. The most serious is called NSAID-exacerbated respiratory disease (NERD) and is characterized by severe asthma flares. It is particularly prevalent in those with nasal polyps and a history of severe asthma.
Of great importance, patients with NERD can be desensitized to aspirin. Because NERD is triggered by all the related drugs, aspirin desensitization effectively allows tolerance of all the NSAIDs. Furthermore, patients with NERD who undergo aspirin desensitization have better control of their nasal polyps and asthma.
In the past, aspirin desensitization was done in the hospital because of the risk of triggering a severe asthma exacerbation. Newer and MUCH safer protocols are available for in-office desensitization. In fact, we are now doing aspirin desensitization in our office Continue reading “ASPIRIN CHALLENGE AND DESENSITIZATION: How, When and Why”