Inhaled Corticosteroids – What Are They, and Why Do I Need Them?

By Harriet Spitzer-Picker, AE-C

When I was a child in the 70s and 80s, I had a double life as a guinea pig.  My asthma was so bad that when new drugs needed testing, Intal (cromolyn sodium) was one, the companies came to me. There were very few medications on the market.  They were not very effective and carried side effects, such as rapid heartbeat, sweating, and dry mouth.

Lesser cases might have had the choice between a pocketknife and a sledgehammer.  Unfortunately, in my case, I had to use a sledgehammer.  Only one drug controlled my asthma.  It was then, as it is now, the strongest asthma medication available, Prednisone, a liquid corticosteroid taken orally. I was on a daily dose of prednisone from the age of 4-12, with all the long-term risks.  No doctor today recommends daily Prednisone, except in the most extreme cases.

As I became a young adult, inhaled corticosteroids (ICS) started to arrive in pharmacies. These medicines promised the benefits of Prednisone without the side effects. I was able to get off oral prednisone everyday and limit its use to the occasional emergency. My asthma was much more manageable once I started these medications. Inhaled corticosteroids were like a miracle for me.  They have improved the lives of many millions of asthmatics.  However, there are some patients out there who should be using them, but are not.  In fact, recent studies show that over 50 percent of asthmatics are not taking their medication as prescribed. Let’s discuss some of the issues that come up all the time in my work as a Certified Asthma Educator.

Fear of Steroids–

Patients hear the word “steroids” and think about bodybuilders, doping scandals, and illegal drug trafficking. I have had parents ask me if their son would grow big muscles by taking Advair.  I have had adult women ask if their facial hair would grow.  I have had many patients say they don’t feel comfortable taking “steroids”.  These fears are unfounded.  Corticosteroids come from the adrenal cortex.  Corticosteroids are anti-inflammatory drugs.  Bodybuilders take anabolic steroids, which come from what we might call the testtubeicles; that is, anabolic steroids are essentially synthetic testosterone, which is definitely not useful for asthma treatment.  They are completely different from corticosteroids. The only time you hear about athletes getting corticosteroids is when they have chronic inflammation and get a cortisone shot so they can play.  Even if they were the same class of medicine, the dosage of inhaled corticosteroids is so small that it is measured in micrograms.  A lifetime of inhaled corticosteroids would add up to less dosage than one syringe administered illegally in a gym.

Feeling Fine– I had a young track runner tell me “I feel fine, I don’t wan’t to take medicines unnecessarily”.  I asked him how often he took his albuterol rescue inhaler.  His reply was that he took two puffs before every practice or competition.  This is poorly managed asthma.  This young man is walking around with inflamed lungs every day, and only providing himself short-term relief without addressing the cause.  If he would adhere to his doctor’s prescription of inhaled corticosteroids, his lungs would function normally with little or no need for the rescue inhaler. Inhaled corticosteroids are a safe and effective class of medication that are the cornerstone of most asthma treatment plans.  Their use has benefitted millions of asthmatics and has prevented many millions of emergency room visits and hospitalizations.  If your doctor has recommended an inhaled corticosteroid for you, please adhere to the plan as prescribed.  It will improve your life as it did mine.

Controller meds from http://www.clivir.com/

Arm photo by fitnessatlantic.com