FCAAIA Notes: Daily inhaled corticosteroids (ICS) are the treatment of choice to prevent symptoms in patients with persistent asthma. If such a patient starts to have flaring symptoms, does increasing the dose even 4-5 fold help? Maybe. Maybe not. Over the years, there have been conflicting studies, as described here.
It seems to me that it has become routine advice that patients double their ICS dose when symptoms flare and they enter the “yellow zone” of asthma control. But any one paying close attention to his patients will know it doesn’t always make a difference. Continue reading “NO BENEFIT TO UPPING INHALED STEROIDS DURING ASTHMA ‘YELLOW ZONE’”
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”