Asthma: Long acting vs short acting inhalers

[Chigworthy]

Dr. Steve, I have a related question about asthma medicine.

I used Serevent and Qvar, with Albuterol occasionally, with great success for a few years. A year ago, my wife's career change left us without coverage for about 5 months. We have full coverage now, but I haven't gone back to the steroidal medicine (I've been using Primatene for rescue).

I am hesitant to return to the steroids because of possible steroidy effects like moon-faceyness. Can these products, used as prescribed (I actually cut my doseage in half and had the same degree of relief), cause these problems?

[Dr Steve]

Dr. Steve, I have a related question about asthma medicine.

I used Serevent and Qvar, with Albuterol occasionally, with great success for a few years. A year ago, my wife's career change left us without coverage for about 5 months. We have full coverage now, but I haven't gone back to the steroidal medicine (I've been using Primatene for rescue).

I am hesitant to return to the steroids because of possible steroidy effects like moon-faceyness. Can these products, used as prescribed (I actually cut my doseage in half and had the same degree of relief), cause these problems?

Chig:

I'm assuming you have something more than "mild intermittent" asthma. Your question deserves a lengthy answer, which I will try to get to this week.

Inhaled steroids are generally well tolerated, but CAN cause some adverse effects from being absorbed into the bloodstream. Here's an article on the worst adverse effects: http://www.medsafe.govt.nz/profs/PUarticles/2.htm. I must say in my experience, most people, when faced with the real possibility of "status asthmaticus" (a life-threatening asthma attack) vs. a theoretical (and generally reversible) reaction to the medication, most will choose the steroid.

I'll try to look into the literature and see if certain steroids are "better" than others in this regard, and will try to get this up this week. I'll make a new thread then.

I could pop off the top off my stupid head with some "Facts" but I'd rather take the time and get it right from the beginning.

your friend,



steve

[Chigworthy]

I don't know how to classify my asthma other than a frequent uncomfortability. I've never been hospitlised for it, but I do get it frequently. Even when I smoked a pack a day and didn't give a shit, it was still just a couple times a day kind of mild discomfort. Of course, the many times when I didn't have a rescue inhaler were more than mildly uncomfortable, but never life threatening in my opinion. The asthma would eventually go away, leaving me with a sore set of lung muscles.

Asthma Americana: My family tells me of my great uncle being prescribed marijuana for his asthma. It come powdered in a shoe-polish-like tin. He would lock himself in the bathroom, sprinkle some in the tin lid, hold it over a flame and hot box the room. Some say he looked forward to attacks. Ah the good old days of medicine.