What Inhaled Steroid is Best for Your Asthma?

By Rick Frea, Health Pro Monday, October 03, 2011
Chances are if you have asthma you have some degree of chronic (it's always there) inflammation in your air passages.  Studies have proven the best and safest way of treating this inflammation is daily use of inhaled corticosteroids.   Inhaled corticosteroids are now a top line tr...
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10/ 6/11 3:32pm

Cortisone inhalers are "front line" largely because of the withdrawal from the market of Intal and alternative forms of chromolyn sodium, which provided many of us complete, effective control of symptoms without the potential side effects of inhaled cortisone.  That said, after a year's experience with Asthmanex, it seems a decent "second line" altho marginally less effective than Intal.

10/ 6/11 4:19pm

I just wanted to add that I was one of those rare people who have a bad (VERY bad) reaction to Advair.  I used it for almost a year, and my breathing just kept getting worse and worse.  Eventually, I stopped it on my own, as it was still a couple weeks until my next internist appointment.  That made me understand why, on the commercials for Advair, they list death as a possible side effect.  I felt like I was going to die.  I had to be admitted to the hospital because I was having such a hard time breathing that I was scared to fall asleep because I was sure I would stop breathing, as even with being awake, it took SO much of my energy to even take one breath.  And, due to that, I had lower than normal blood oxygen levels.  I guess the death side effect happens when people have a reaction to Advair like I did...either experiencing a severe asthma attack while on the medication, or experiencing a severe asthma attack after stopping the Advair, even as soon as one day after stopping.

 

Just wanted to put the word out there as a caution, because it does happen to some people, so be aware!

10/ 6/11 10:36pm
What is the safe length of time prescription for taking corticosteroid in children? Specifically an eight year old taking Qvar.
10/ 7/11 9:41am

As an allergist and asthma specialist, I feel I should add a few comments.  Much of the detail of this article is accurate and helpful, so thank you for raising some good points.  We have several effective products on the market for asthma care, and there is not always one right medicine for everyone.  The primary single inhaled corticosteroids that are used most frequently now are Flovent, Qvar, Asmanex, Alvesco, and Pulmicort, which are chosen based on ease of use, insurance coverage, and other fine details of someone's history and exam.  Flovent and Qvar are given by metered-dose inhaler (a "pump"), so they are easier to use in children with a spacer device, unlike Asmanex and Pulmicort, which require good coordinated inhalation for use (which can be done as early as 5 years of age).  Pulmicort is also available in nebulizer form, so it is great for smaller children.  Each of these steroids have many childhood studies supporting their safety, though it is good to be honest that they may potentially reduce growth potential by 1 cm (though uncontrolled asthma and oral steroid treatments for asthma flares may also stunt growth).  My personal opinion is that Qvar is not only for "hardluck" asthma.  Its smaller particle size may make it a good first-line option for patients, especially if their physician believes they may have contributing small airway inflammation, which most asthmatics probably have.  Flovent also works very well for asthma, and it has a counter on the device to help you keep track of how many doses are left (like Pulmicort, Alvesco, Asmanex, Advair, Symbicort, and Dulera).  Alvesco is given by a "pump" device, is newer, and has an excellent safety profile with the promise of help of small steroid particle size as well, but it has not been put through enough childhood studies to have it approved for less than 12 years of age.  I have found for the infrequent child with behavioral side effects from inhaled steroids, Alvesco's reduced systemic bioavailability may make it induce less potential side effects.    I have many adult patients who feel like their asthma was uncontrolled on combination therapy and improved with the use of Qvar or Alvesco, potentially due to their small particle size accessibility to the whole lung.  Correction to the article's description of Dulera:  it is mometasone (the steroid in Asmanex) and formoterol (the LABA in Symbicort).  All 3 combo devices (Advair, Dulera, and Symbicort) are good products, so it depends on insurance, the doctor's preference, and the patient's preference for choosing which one to try.  Because some people can have adverse effects from steroids (such as thrush/hoarseness) or LABAs (increased heart rate and blood pressure, hyperactivity or restlessness, or paradoxical bronchospasm, aka worsening asthma),  it's good to give each medicine an honest trial for 2-4 weeks.  If you aren't feeling better, you shouldn't wait to talk about other treatment options with your doctor.  Hope this helps. 

10/ 8/11 10:48pm

I have been taking Flovent for 10 years and only need 1 puff at bedtime. The doctor that put me on Fluticasone told me to hold the inhaled burst of Flovent in my lungs for as long as posible, then exhale  thru my nose and inhale again thru my mouth and hold again for as long as I can. Immediately gargle with warm to hot water water without swallowing and rinse my throat as deeply as possible without swallowing. I have not had one incident of an asthma attack in my whole experience of using Flovent.

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By Rick Frea, Health Pro— Last Modified: 12/12/11, First Published: 10/03/11