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: It is encouraging that asthma is a less common cause of school absence and hospitalization than it was, but that doesn’t necessarily mean overall asthma control is that much better. Maybe we are treating more aggressively and earlier to avoid the necessity of hospitalization and thus getting children back to school sooner.
One of the best ways to avoid asthma exacerbations is to maintain the best possible control BETWEEN flares. Far too often, I see children and adults with asthma who think they are fine on a day-to-day basis but have frequent symptoms, poor sleep, exercise intolerance, and low lung function. Bodies are smart; Continue reading “CDC: PEDIATRIC ASTHMA CONTROL IMPROVING IN U.S.”
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: It is heartening to see this report of declining asthma mortality, particularly among older Americans. There are probably numerous reasons why including better recognition and therefore more frequent diagnosis of the disease, more appropriate preventive treatment plans, and newer medications including monoclonal antibodies that decrease asthma morbidity and mortality.
Of course, asthma mortality rates had increased steadily for a couple of decades before they started to level off (and now apparently decline). Nonetheless, several thousand Americans still die every year from asthma. Those with poorly controlled and severe asthma are at greatest risk.
Many people do not even recognize that their asthma is not well controlled, Continue reading “ASTHMA DEATH RATE FALLING IN U.S.”