There is, however, some evidence that higher doses of inhaled corticosteroids can result in adverse BMD changes. In a high-quality RCT of 412 participants, aged 40 to 69 years, with mild to moderate COPD, use of higher-dose triamcinolone (1200 mcg/day) was associated with decreased lumbar and femoral neck BMD over 3 to 4 years. 4 The differences in BMD between the inhaled corticosteroids and placebo groups at the femoral neck and lumbar spine were % ( P <.001) and % ( P =.007), respectively. However, the risk of fracture or height loss did not increase at follow-up.
Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of COPD when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe the medicine in.
Viewer Question: What are the possible long and short term side effects from
inhaled corticosteroid drugs taken for asthma? Is it possible to experience
similar side effects on high doses of the inhaled drugs as on the orally
administered drugs (. prednisone )? There are some potent new inhaled drugs,
. Flovent, that are effective in treating asthma but I was wondering if these
drugs are absorbed into the bloodstream.
Doctor's Response: Current maintenance therapy for asthma is directed primarily at airway inflammation. The application of topical inhaled steroids on the air passages is a very effective means of managing the chronic symptoms of asthma. There are a variety of inhaled steroids available by prescription. These steroids all act in a similar fashion to oral steroids but with fewer side effects. As the dose of inhaled steroids increases so does the potential for some of the more serious steroid complications. The fluorinated steroids fluticasone (Flovent) and budesonide (Pulmicort) are the most potent. It is important to use the lowest effective dose that optimizes lung function and minimizes symptoms. Most of the steroid inhalers when prescribed at the usual dose have an immeasurable effect on the body (that is outside of the air passages). Some potential effects include the suppression of the hypothalamus (in the brain) and the adrenals (above the kidneys). These glands are involved in our bodies response to stress. Measurement of their function is a very sensitive way of determining the impact inhaled steroids may have on the body. When the function of these glands is suppressed than the many side effects seen with oral steroids may also occur. The most common side effect of inhaled steroids is oral candidiasis (thrush). This is easily treated and its occurrence minimized by using a spacing device. Exacerbation of glaucoma has also been reported. To summarize, inhaled steroids are an excellent medication for the treatment of asthma. Their safety profile is terrific when used by knowledgeable practitioners. Thank you for your question.