Tag: inhaled steroids

ASSOCIATION BETWEEN INHALED CORTICOSTEROID USE AND BONE FRACTURE IN CHILDREN WITH ASTHMA

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”

ASTHMA DURING PREGNANCY: EXACERBATIONS, MANAGEMENT, AND HEALTH OUTCOMES FOR MOTHER AND INFANT

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”

ASTHMA DURING PREGNANCY: EXACERBATIONS, MANAGEMENT, AND HEALTH OUTCOMES FOR MOTHER AND INFANT

FCAAIA Notes: In pregnancy, about 1/3 of mothers with asthma get worse, 1/3 get better, and 1/3 remain the same.  The pattern tends to be the same from one pregnancy to the next.  The control often improves in the last trimester. The health of the mother is paramount during pregnancy.  Guidelines for the treatment of asthma in pregnancy have been around for a long time and are reviewed and updated regularly.

Poorly controlled asthma is more of a risk to the fetus than the medications used to treat it.  Continue reading “ASTHMA DURING PREGNANCY: EXACERBATIONS, MANAGEMENT, AND HEALTH OUTCOMES FOR MOTHER AND INFANT”

REVISITING THE SAFETY OF LABAS IN CHILDREN WITH SEVERE ASTHMA

FCAAIA Notes: Twenty years ago the SMART study suggested a risk of long-acting beta agonists (LABA) use, However, the rail was associated with the use of LABA alone and NOT with the concurrent use of inhaled corticosteroids (ICS). Study after study shows that when used in combination with ICS, LABAs do not increase risk of asthma morbidity or mortality. Of course, the patients who need LABAs along with their ICS have more severe asthma to start with, so their risk is greater than those who do not require LABAs.

An important point is that many patients who use ICS/LABA combinations have never tried and ICS alone. Continue reading “REVISITING THE SAFETY OF LABAS IN CHILDREN WITH SEVERE ASTHMA”

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