Side Effects of Inhaled Steroids-Mike 4.22.13

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Steroids for asthma - are these going to "bulk me up?! Honest discussion on side effects of asthma therapy:

Steroids for asthma - are these going to "bulk me up?! Honest discussion on side effects of asthma therapy Michael J. Welch MD, FAAAAI Clinical Professor, University of California, San Diego School of Medicine Co-director, Allergy and Asthma Medical Group and Research Center

Remember the “rule of 2’s” :

Remember the “ rule of 2 ’ s ” Symptoms: 2 days a week Symptoms: 2 nights a month Albuterol canisters: 2 per year Flareups: oral steroids, UC, ER visits: 2 per year If you meet rule of 2 ’ s: need a controller/preventer medication !!! i.e. take medication every day of your life!!!

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Guidelines for the Diagnosis & Management of Asthma NIH/NHLBI NAEPP EPR-3 2007 “ Asthma play book ” Best controller/preventer medication? A: Inhaled steroids

Remember Asthma 101?:

Remember Asthma 101? 3 problems in asthma Muscle spasm Inflammation Overproduction of mucus

Asthma: constant inflammation of the airways:

Asthma: constant inflammation of the airways Location Generation Martin RJ. J Allergy Clin Immunol . 2002;109:S447-460. Reprinted with permission of the American Thoracic Society. Copyright © American Thoracic Society. Mauad T, et al. Am J Respir Crit Care Med . 2004;170:857-862. *Images reproduced with permission from Dr. Francis Green, Department of Pathology and Lab Medicine, University of Calgary. Small airway in adult control subject Small airway in adult subject with fatal asthma Normal* Asthma* Fatal asthma*

Anti-inflammation medication = inhaled steroid:

Anti-inflammation medication = inhaled steroid Muscle spasm Inflammation Overproduction of mucus Inhaled steroids

Why inhaled steroids? ‘cause they do it all!:

Why inhaled steroids? ‘ cause they do it all! Major breakthru in the 1970 ’ s symptoms need for albuterol lung function exacerbations/admissions/ER visits overall asthma control quality of life

Lots of inhaled steroids:

Lots of inhaled steroids

Steroids??? Yuk!!!!! No way!!!!!:

Steroids??? Yuk!!!!! No way!!!!!

Dealing with steroid phobia :

Dealing with steroid phobia Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience

Inhaled steroids …… :

Inhaled steroids …… Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience

Inhaled steroids …… :

Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience Inhaled steroids ……

Dealing with steroid phobia :

Dealing with steroid phobia Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience

Relative doses of inhaled versus oral steroids:

Relative doses of inhaled versus oral steroids 1 Inhalation Flovent twice daily = .100 mg = .018 mg to body versus 2 treatments with oral prednisone per year: 60 mg per day X 5 days = 300 mg X 2 episodes = 600 mg EXAMPLE

Inhaled steroids ….:

Inhaled steroids …. Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience

Inhaled steroids….. :

Inhaled steroids….. Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience

Inhaled steroids… :

Inhaled steroids… Not same as anabolic Not same as oral ( “ bad type ” ) Keeps patients from “ bad type ” Work topically Low doses effective Almost 40 yrs of experience 1970 ’ s

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What moms, dads, docs fear

Long-term growth effects of inhaled budesonide:

Long-term growth effects of inhaled budesonide Budesonide Nedocromil Placebo cm 0 1 2 3 4 Time (y) 0 130 135 140 150 160 145 155 cm/y Standing height Childhood Asthma Management Program Research Group. N Engl J Med 2000;343:1054-63. N = 1041; ages 5 – 12 yrs cm Height difference about 1 cm = 0.4 inches

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Great medications Steroid phobia Flovent Q Var Pulmicort Dulera Advair Symbicort Alvesco

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