THE BENEFITS OF USING STEROID INHALERS

I often hear from my patients about someone with asthma who became very sick, was admitted in hospital in a serious condition or died. In all these situations, the commonest answer that emerged was the non-usage of the steroid inhaler (preventor).

The term "steroids" is scary to many. It has earned notoriety in sports due to various other reasons. But, in respiratory medicine, it is a widely prescribed medicine. Although heavily prescribed, they are often not used either because patients misunderstand the side effects or they don’t perceive the benefits immediately as with bronchodilators (relievers).
How it acts

Bronchodilators are used to open the airways quickly but the steroid acts slowly to bring the airways back to normal by reducing the inflammation so that the need for bronchodilators is reduced. By not using steroid inhalers, the inflammation continues unhindered resulting in piling up of mucus and swelling of the mucosa. At this stage, even if one uses a bronchodilator the effect is not perceived. If more doses are used, the benefit of bronchodilation is not perceived but toxicity starts. One of the serious side effects of reliever inhalers without steroid inhalers is sudden death due to uncontrolled asthma.

Another problem that occurs with regular use of bronchodilators without steroid inhalers is the development of fixed airway abnormalities. Simply put, the routine reliever dosage cannot open airways and a bigger dose does not mean increased benefit. At this stage even steroid inhalers would take longer to repair the airways or may fail.
Importance of inhalers

This highlights the importance of the steroid inhalers. In one study, Suissa and colleagues looked at 31,000 people between the ages of five and 44 years. Most patients used steroid inhalers. The researchers found that for every additional canister of steroid inhaler used the chances of death from asthma decreased by 21 per cent. They found a bigger effect when they looked at inhaled steroid usage in the last six months — a 54 per cent decrease in asthma deaths for every additional canister used. This was published in New England Journal of Medicine in 2000. The death rate increases significantly in the first three months if one stopped using steroid inhalers.

The message is: even in low doses steroids accrue benefits. In optimum doses not only is asthma control optimum but also serious problems ending in death can be prevented. Another reassuring aspect is the absence of side effects due to steroid inhalers. Clearly the benefits outweigh the risks.