Steroids Blog

Even though asthma is one of the major reasons for admissions to hospitals and a common chronic disease among young children yet 26-45 percent of children face inadequate asthma control, as per a review in CMAJ (Canadian Medical Association Journal).

This review was produced as an initiative of the Canadian Thoracic Society and incorporated the latest scientific information derived from randomized controlled trials since the Canadian Pediatric Asthma Consensus Guidelines were published in 2003.

From Sciencedaily.com:

The review provides key points for distinguishing between transient asthma and chronic asthma in preschoolers and information on managing both types.

For children with intermittent asthma, using inhaled corticosteroids only during attacks does not appear to be effective. Regular therapy with inhaled steroids should be used for children with more severe intermittent or persistent symptoms. Treatment with leukotriene receptor antagonists during the viral season may help to reduce symptoms and visits to health care providers. The possibility of another condition should be considered if children do not respond to optimal therapy.

The authors stated that more research is pending to examine the effectiveness of treatment options in young children.

A cataract is a clouding that develops in the eye. It may develop in the crystalline lens or in its envelope. There different types of cataract. Among those are congenital cataracts and secondary cataracts. Under secondary cataracts is a type known as drug-induced cataract. This type is usually due to corticosteroids use.

A population-based study was recently conducted by the Centre for Vision Research, University of Sydney in Australia. They obtained initial baseline information from asthma patients, who have been using either oral steroid for a month, or have used inhaled corticosteroid at least once. The study then conducted examinations five or ten years after initial baseline information were obtained.

Clinical trials suggest that long-term steroid use and its cumulative dosage increased the patient’s risk for developing cataracts. There were two types of cataract found to stem from steroid use; the nuclear cataract and the posterior subcapsular cataract. The nuclear cataract develops in the center of the lens while in posterior subcapsular cataract (PSC) the cataract develops in the area of the lens.

These findings further lead to additional studies to determine the effectivity of a combined oral and inhaled steroids therapy against using inhaled steroids alone. They found out that both exhibited similar effects. Clinicians therefore, must be cautious in prescribing the combined therapy to their patients as this may cause higher risk for developing cataracts.

According to Medical News Today:

“Our findings could mean that combined steroid use, when it results in high cumulative dosage over relatively long periods, increases risks for two types of cataract,” said lead researcher, Jie Jin Wang, MMed, PhD, Centre for Vision Research. “When clinicians prescribe both steroid forms, the cumulative, combined dose should be considered. Also, recent clinical trials indicate that combined steroids are not more effective than inhaled steroids alone in treating asthma.” He added that further investigation is needed to determine whether asthma plays a role in nuclear cataract development.

General Physicians (GPs) have warned the medical fraternity not to prescribe inhaled steroids to their COPD patients at an earlier stage as they can increase the chance of pneumonia.

The Medicines and Healthcare Regulatory Agency that is considered as the government’s drug safety watchdog suggested that steroids are used very much in advance than what the present medical guidelines recommend. It was revealed by the GPs that a combination of LABA (Long acting β2-agonists) with inhaled steroids does not bring any noteworthy benefits in cases of mild ailments but they do increase the risk of attracting pneumonia.

From Pulsetoday.co.uk:

The government’s drug safety watchdog, the Medicines and Healthcare Regulatory Agency, suggests steroids ‘are being introduced earlier than current guidelines recommend’.

It says combining LABAs with inhaled steroids has no proven significant benefits in mild disease, but that steroids significantly increase the risk of pneumonia.

NICE guidance, currently under review, says inhaled steroids should be added for severe disease with an FEV1 under 50% and where there are repeated exacerbations.

Combination is better than monotherapy in all trials that have compared the two treat-ments, but the benefit is limited.

Inhaled steroids should be limited to when COPD progresses to severe disease, and never on their own, the MHRA says.

These findings were termed as ‘very sensible’ by Dr Steve Holmes, a GP in Shepton Mallet, Somerset and education lead of the General Practice Airways Group.

As per a latest study conducted by the National Heart, Lung and Blood Institutes Asthma Clinical Research Network and Stanley Szefler, M.D., lead author on the paper and Head of Pediatric Clinical Pharmacology at National Jewish Medical and Research Center, it was found that low to medium doses of inhaled steroids can benefit patients suffering from persistent asthma.

Szefler said that individual patients may respond in a different manner than others when administered with inhaled steroids and this is where other therapies may be implemented if low to medium doses of inhaled steroids fail to bring clear benefits for them.

The study clearly indicated that inhaled steroids are usually more than enough to bring improvements in the functioning of the lungs in patients with persistent asthma.

From News.Bio-Medicine.Org:

“Dr. Szefler recommends that doctors whose patients do not respond with low to medium doses of inhaled steroids consider supplementing them with non-steroidal medications, such as long-acting beta agonists and leukotriene modifiers, before prescribing high doses of inhaled steroids. When high doses of steroids are used for several years, they may be associated with an increased risk for adverse effects, such as osteoporosis, cataracts and glaucoma. However, higher doses of inhaled steroids may still be needed to help some patients control their asthma, said Dr. Szefler. He advises doctors to monitor any patients taking high doses to determine whether the benefits outweigh the risk for adverse effects. The new findings indicate that benefits vary widely for individual patients.

The research team studied 30 patients with persistent asthma. The patients received three different doses of an inhaled steroid, each administered for six weeks at a time. The researchers examined two inhaled steroids in this study, fluticasone propionate (FloventTM), and beclomethasone dipropionate (VancerilTM) both in the canister form along with a spacer device. They evaluated benefits primarily by measuring lung function and airway sensitivity. Cortisol levels were measured to gauge the effect of the inhaled steroid on the body’s normal function and the risk for adverse effects.

To the research teams surprise, eight of the 21 patients (38%) who completed all lung function tests showed less than a 5% increase in lung function at any dose, much less than expected. Five (23%) had a 5% to 15% percent increase in lung function, while eight (38%) had more than 15% improvement in lung function. A similar degree of variability in response was shown for the change in measures of airway sensitivity.”

The study also suggested that patients who have been administered with high doses of inhaled steroids need to be monitored so that it could be determined whether the benefits of such high doses outweigh the risks for adverse effects.

This study is regarded as quite important as it was able to highlight considerable variations in responses to the prescribed medications. The study also helped in the initiation of a whole new area of research that seems to have an ability to improve management of asthma.