Oral corticosteroids are often used in the asthma arsenal to reduce inflammation in acute attacks, or when inhaled steroids are not cutting it or are not tolerated. Unfortunately, while these medications work well in inflammation, oral corticosteroids have a whole host of side effects. Some of the most concerning long-term side effects include osteoporosis, diabetes, cardiovascular disease, and adrenal suppression. These side-effect risks can increase the longer you use the medication, so limiting oral corticosteroid use is essential for the long-term health of the patient. These are a few ways to help limit your need for these medications.
See a specialist
Seeing a specialist, like a pulmonologist, is key in getting your asthma under good control. A specialist has extensive training in diagnosing and treating asthma and can often prescribe medications that your general practitioner may not be using. We found that our daughters’ specialist was able to increase certain medications as well as prescribe new ones that our daughters would not have had access to otherwise. It has proven to be essential in getting their asthma under control. Specialists can also help you to determine what is triggering your asthma, more closely monitor your lung function, and develop a clear asthma action plan to reduce future attacks and help you know how to deal with an attack when it occurs.
Address the environmental triggers
What triggers asthma exacerbation in one patient may not be a trigger for another. However, some common triggers can include: allergies like mold or pollen, smoke, dust mites, pet dander, air pollution, chemicals like cleaning agents, weather changes, strong emotions, and even exercise. It is essential to work with your specialist to determine what triggers are specific your asthma as well as develop an asthma action plan for attacks. Determining if your asthma is intrinsic, extrinsic, or combination can help further identify triggers. Obviously, some of these triggers are unavoidable, but limiting the exposure to the controllable factors can be key in reducing the acute attacks that require oral corticosteroids.
Upper respiratory infections can be a huge trigger for an asthma flare-up. In fact, one of our girls finds that these infections are the main trigger for her flare-ups and a frequent reason for her oral corticosteroid use. Utilizing proper hand-washing techniques and avoiding anyone who has been sick within the last two days can help you stay well during cold and flu season. Cleaning surfaces frequently touched can limit the spread of germs in the home, workplace, or school. Be careful to use a mask when dealing with chemicals or have someone else do the cleaning, because inhaling fumes from cleaning products, especially bleach, can be very hard on asthmatics. Be sure to get any recommended vaccinations, such as the flu or pneumonia vaccine, done in a timely manner, because they can take two weeks to offer full protection
Omalizumab (Xolair) is indicated for moderate to severe persistent asthma that is caused or exacerbated by allergies, a condition known as allergic asthma. Xolair is currently the only biologic used in the treatment of asthma, but it only works for allergic-type asthma.
Xolair injections work by binding to the IgE antibody that is produced in allergic reactions and neutralizing its actions. This reduction of flare-ups related to allergic exacerbation reduces the need for acute treatments with oral corticosteroids. One of our daughters is currently using Xolair We have been able to reduce her inhaled steroids and allergy medications, and she has not needed oral corticosteroids since beginning the treatment.
A new biologic being investigated for use in asthma is benralizumab, an anti–interleukin-5 receptor α monoclonal antibody. The Phase 3 trial, known as ZONDA, found a four times greater reduction in prednisone, a commonly used oral steroid, in the benralizumab group as compared with placebo. Unlike omalizumab, this medication targets eosinophils, cells that cause inflammation in asthma, and may work for patients whose asthma is related to their overproduction, but more research is needed to better determine the target patient group. It’s exciting to see that this medication may provide an additional tool in reducing oral corticosteroid use in asthma in the near future.
Whatever the reason for your oral corticosteroid use, it is important to work with your physician to limit the need for this medication whenever possible. Remember: Do not make any changes to your treatment plan without your doctor’s approval.
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Jennifer Rackley is a nutritionist and mother of three girls. Two of her children have dealt with acid reflux disease, food allergies, migraines, and asthma. She has a Bachelor of Science in dietetics from Harding University and has done graduate work in public health and nutrition through Eastern Kentucky University. In addition to writing for HealthCentral, she does patient consults and serves on the Board of Directors for the Pediatric Adolescent Gastroesophageal Reflux Association.