Treatment of Asthma

Inhaled Corticosteroids and Asthma Therapy

Inhaled corticosteroids have proven to be one of the most efficient and pertinent long-term treatment options for asthma sufferers, particularly when the symptoms of asthma grow to be mildly or moderately severe. Most compounds currently prescribed in inhalers for asthma usually contain a corticosteroid and a long-acting bronchodilator - a combination that is now regarded as the variable cornerstone of any type of extended therapy for asthma patients.

Let us review what it is exactly that these medical substances can do for you:

  • As you have probably heard, corticosteroids work by reducing inflammation. We say "reduce" but the proper term would be "inhibit", since inflammation by itself is regarded as a helpful mechanism that allows our bodies to heal faster.
  • Normally, inflammation causes the tissues to swell and expand, increasing blood flow and various metabolic processes, and consequently hastening various recovery functions. In the respiratory tract, namely - the bronchi, the same mechanism is also used as a trigger for the secretion of viscous mucus in an attempt to envelop and subsequently rout any dangerous elements out of the system.
  • In case of allergies and asthma, this kind of reaction is ill-placed, since the organism starts to react abnormally to practically harmless substances, such as pollen, launching a full-on, guns blazing assault on the would-be invaders. Steroids artificially turn the alert level back to green, stopping inflammation and allowing the organism to take care of the irritants without exerting itself.

Long Acting Bronchodilators

If you are familiar with short acting bronchodilators (used in so called "emergency" inhalers), the two bronchodilator types are very much alike, with a single exception. All bronchodilators work by expanding, or "dilating" the bronchi - airway tubes through which air can pass in and out of the lungs. What long acting bronchodilators do is they provide the same effect of dilation, but do so over extended periods of time. This activity term varies for different compounds, but most of them will keep delivering a diminishing effect over 4 to 7 days, with trace benefits felt for as long as one month.

Terms of Treatment with Corticosteroids

Inhaled corticosteroids are generally recommended if the patient afflicted with asthma has to use short-acting relief inhalers more than twice a week, meaning that the symptoms are recurrent and severe enough to require the use of inhalers on a regular basis. Several studies conducted over the last 6 years indicate that early implementation of "controller" treatments can greatly improve the long-term wellbeing of a patient, as opposed to using steroids only when the condition has deteriorated to the point when no other treatment can efficiently contain the symptoms. Although this concept is not yet officially integrated into the prescription guidelines, many doctors tend to support it. Long story short - if your doc thinks you should start an extended treatment program as soon as possible, it is a good idea to do just that.

Here's what you can expect when using these medications:

  • The treatment with inhaled corticosteroids is usually received quite well by most patients, including children. This fact has been proven numerous times in a number of studies conducted in Europe, Canada, UK, Australia and the US. If you are interested in the concrete numbers, it is easy to find relevant information via the search engines by including the term "study" (as in "research") after the search phrase.
  • Depending on the particular compound, corticosteroids may stay in your system for weeks, or even months. For the most part, they are metabolized almost entirely during the first 24 hours, leaving a small amount of active components present in the organism. For this reason, the effects of steroids tend to stretch over long periods of time.
  • The need for repeated use of long-term treatment inhalers (usually twice a day, in the morning and in the evening) arises from the necessity to maintain even levels of the active components upon the affected tissues, so that the gradual beneficial effects the drugs produce can build up steadily.
  • In general, the initial positive effects of steroids can be felt 14 days after you begin the treatment, if you follow the regimen correctly. It may sound unpromising, but these results can be reinforced by further applications of the drug.
  • A general "minimum" of productivity for inhalers containing a combination of corticosteroids and long-acting bronchodilators is defined as 44% reduction in the severity and recurrence rate of adverse symptoms for patients taking this medication for at least 3 months. The study was performed for people suffering from mild to severe recurring symptoms of asthma, and these results were observed over a 2 year treatment period.

Long Term Asthma Treatment Reminders

Be aware that all of these things only apply if you follow your treatment regimen to a "T". True, some treatment is better than no treatment, but both the bronchodilators and steroids can only bring benefits over the long term if the concentration of the active components is maintained at relatively even levels throughout the treatment - that is why these drugs need to be taken twice a day. Skipping your required doses can undermine all of the efforts you put into this treatment.

One study, featured in the "Primary Care Respiratory Medicine" scientific journal, shows that at least 27% patients do not use their preventer inhalers for asthma every day, as instructed by their healthcare providers. The prevalent reason for this is that most people simply do not feel like they need to use the inhaler since they are "doing fine" without it anyway (51%), and other times they simply forget to use it (18%). Such inadequacy is one of the reasons long-term treatments do fail, because no matter how efficient a single drug may be, it will be powerless in cases of improper use. If you decide to take on a long term treatment program, it is better to stick with it, since the downsides and dangers of a "coming and going" kind of approach to treatment can be very troubling.

Corticosteroids for Asthma In Children

Some researchers say that inhaled corticosteroids may negatively impact a child's growth and development. Well, technically, this claim has a sliver of truth in it - according to a recent study in pediatrics performed in Stanford University School of Medicine, children with asthma who have been taking high doses of inhaled corticosteroids for a year of consistent treatment have shown a mean reduction in height of 0.2 inches (slightly varies for different compounds), relative to the height of other children in the same test group who were taking placebo. It is worth mentioning that these kids had to endure mild to severe persistent asthma symptoms, which would not just disappear on their own. Such borderline severe cases of asthma in children are known to cause growth impairment and a great multitude of other disorders on their own if left untreated (statistically, at least 0.8 inches of gross height reduction a year), almost always doing much more damage than any drugs ever could. It really comes down to choosing the lesser of two evils, and inhaled steroids have shown to be much less adverse than untreated asthma.