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Beta2-agonists have serious interactions with certain other drugs, such as beta-blockers, and patients should tell the doctor about any other medications they are taking. People with diabetes, heart disease, high blood pressure, hyperthyroidism, an enlarged prostate, or a history of seizures should use these drugs with caution.
Loss of Effectiveness and Overdose. Short-acting beta2-agonists become less effective when taken regularly over time, which increases the risk for overuse. Overdose can be serious and in rare cases even life threatening, particularly in patients with heart disease.
Anticholinergic Drugs
Two inhaled drugs, ipratropium bromide (Atrovent) and tiotropium (Spiriva) act as bronchodilators over time. Neither is highly beneficial for acute asthma attacks. Moreover, the drugs are not approved specifically for asthma. They may, however, have some benefits:
- They may be useful for certain older patients with asthma who also have emphysema or chronic bronchitis.
- Combining them with a beta2-agonist might help patients who do not initially respond to treatment with a beta2-agonist alone.
Oral (Systemic) Corticosteroids
Common oral corticosteroids include prednisone, prednisolone, methylprednisolone, and hydrocortisone. They very effectively reduce inflammation. They are generally used for asthma flareups that do not respond to inhaler medications. In some severe cases, they may be used as maintenance therapy. Usually, the dosage starts out higher and is then gradually reduced over a 5 - 7 day period.
Adverse effects of prolonged use of oral steroids include cataracts, glaucoma, osteoporosis, diabetes, fluid retention, susceptibility to infections, weight gain, hypertension, capillary fragility, acne, excess hair growth, wasting of the muscles, menstrual irregularities, irritability, insomnia, and psychosis. Osteoporosis (bone thinning) is a common and particularly severe long-term side effect of prolonged steroid use.
No one should stop taking any steroids without consulting a doctor first. If the doctor orders steroids withdrawn, regular follow-up monitoring is necessary. Patients should talk to their doctor about ways to prevent adrenal insufficiency during withdrawal, particularly during stressful times when the risk increases.
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Review Date: 05/03/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
