The good news is that many of the fears people have about the risks of asthma medicine have little foundation in fact. Actually, most asthma medicines are quite safe. Also the risks to your health from not taking your asthma medication as prescribed are probably greater than any possible side effects of asthma medicine.
Let's consider the different types of asthma medicine and their potential side effects or risks.
Inhaled Steroids
Inhaled steroids are considered the most effective long-term treatment for people who have persistent asthma. Examples are budesonide and fluticasone. Unfortunately, some people hear the word "steroid" and associate it with negative effects. But the kind of steroids that most people are thinking of are called anabolic steroids, the kind of drugs that athletes sometimes use to enhance performance.
Anabolic steroids are completely different from the kind of steroids used to treat asthma. The inhaled steroids used for asthma are similar to natural substances found in the human body, and they have few side effects. In fact, the benefits of inhaled steroids far outweigh any risks, especially at low to medium doses.
Minor side effects sometimes can occur, however, including the following:
- Thrush, which is a fungal infection in the mouth and throat, is one of the most common side effects. Using a spacer with the inhaler can help avoid this problem.
- Dysphonia is a type of vocal stress that sometimes occurs when the inhaled steroid dosage keeps increasing. Again, using a spacer can help get rid of this, as can reducing the dosage temporarily.
- Reflex cough and bronchospasm are two other effects you might have if you inhale too quickly through your inhaler. Using the spacer helps with this one too, as will slowing down and breathing in slowly and steadily when using the inhaler.
One potentially more risky side effect of inhaled steroid use in children is the possibility of a growth delay. Some, but not all, studies suggest that there may be at least a short-term delay in growth when children are treated with inhaled steroids.
However, more and longer studies are needed to fully explore this potential effect. It's important to note that growth in children can vary greatly anyway. Also, the current National Institutes of Health, National Heart, Lung, and Blood Institute Asthma Guidelines state that, based on long-term studies, these short-term delays do not have any effect on final adult height. Plus, poorly controlled asthma itself may also delay growth in children.
In the end, what we know is that the considerable benefits of inhaled steroids far outweigh the risks.
Long-Acting Inhaled Beta Agonists
Another type of medicine used to treat asthma is the long-acting inhaled beta agonists category of drugs. These drugs are sometimes used by themselves to treat asthma, but often they are combined with an inhaled steroid to limit the strength of the steroid needed.
However, some concerns have been raised about this class of drugs. There have been some reports that occasionally drugs such as salmeterol could cause sudden worsening of asthma symptoms and possibly death. Studies have not been able to conclusively prove that this is a significant risk in people who use this type of medication correctly. Still, experts recommend now that long-acting beta agonists only be used in conjunction with inhaled steroids.
Short-Acting Beta Agonists
Short-acting beta agonist medicines, such as albuterol, are used as quick-relief medicines for treating asthma attacks. They are an important part of most asthma management plans.
However, when asthma is well-controlled (usually with some sort of preventive medication such as an inhaled steroid), your quick-relief inhaler should only need to be used occasionally. But when the short-acting beta agonist is used with increasing frequency, there is often a link with increased risk for death. This link may be more about the fact that the asthma is not controlled well, rather than from the use of the quick-relief inhaler.
At any rate, there is no documented benefit from frequent, regular use of a short-acting beta agonist in treating asthma.
Immunomodulators
Xolair is in a new class of asthma drugs called immunomodulators, which means it acts directly on the immune system to control asthma. It's considered an effective asthma treatment, especially in people with severe persistent asthma that has not responded well to other treatment. However, the FDA recently issued what is known as a "black box warning" for Xolair. In a few cases (1 out of 1000), it has been known to cause severe allergic reactions.Though this side effect is of concern, the benefits of the drug for some people cannot be discounted. So, experts emphasize that if you take it, that you be prepared for an allergic reaction and know what to do if one occurs.
In Summary
Taking any kind of medicine carries some degree of risk. Asthma medicines are no exception. However, it's important when making medicine decisions to weigh any possible risks against the potential benefits. In the case of asthma medications on the market today, benefits nearly always greatly outweighs any risk of side effects or harm. But if you have any concerns at all about your asthma medication, be sure to talk with your doctor.
Source:
National Institutes of Health, National Heart, Lung, and Blood Institute. Guidelines for the diagnosis and management of asthma. Expert panel report 3. NIH Publication No. 97-4053, August 2007.
