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Tuesday, December 22, 2015

Are Asthma Medicines Safe?

The following was originally published at on July 2, 2015.

Are Asthma Medicines Safe?

Asthma medicines are essential for helping asthmatics prevent and control their asthma. However, sometimes one of our medicines makes the news, and it creates a scare. Sometimes these make us wonder: are asthma medicines safe? Here is a look at some scares regarding asthma medicines, and what was learned from them.

Rescue inhalers linked to increased risk of death. When rescue inhalers were first introduced back in the 1950s, asthmatics breathed sighs of relief, literally. This was what they wanted for thousands of years. But then something unexpected happened: asthma death rates spiked.

Initial fears caused many doctors to quit prescribing them, leaving many asthmatics without the relief inhalers they needed. But then reason set in. Experts figured it wasn’t the inhalers, but patients over reliance on them. Instead of seeking expert consultation when symptoms were observed, asthmatics would puff and puff until it was too late.

The lesson learned from this was essentially to encourage physicians to educate patients about rescue inhalers. If symptoms persist, one must not keep puffing on the inhalers, but to seek medical consultation. If you observe you are using your rescue medicine more frequently than usual, it's time to seek help.

Long Acting Bronchodilators (LABAs) linked to increased risk of death. During the 2000s, combination inhalers like Advair and Symbicort were proven to help control and prevent asthma, making it so rescue inhalers were less likely to be needed. Then reports came of some asthmatics found with LABAs clutched in their grasps.

While some reports suggest LABAs can make asthma severe and fatal, others suspected the causes of death were related to lack of education. Rather than just using these medicines twice daily as prescribed, some were using them as rescue inhalers. Again, rather than seeking help, they were over relying on their inhalers.

The general consensus now is that LABAs should be used exactly as prescribed, and never more than once or twice a day. If asthma symptoms occur between doses, patients should refer to their athma action plans. These are plans that help asthmatics decide what action to take when symptoms are felt, and when to call for help.

Singulair linked with suicide. This medicine was introduced to the market in 1998 to help people with allergic asthma. Ten years later, one mother suspected the medicine to be linked to her child’s suicide. While subsequent studies showed there was no such link, a black label on the box warns of the potential link.

This is just another of those situations where a physician must alert patients of all the potential risks of a medicine, and weigh them against the potential benefits. If you observe a side effect, call your physician immediately. Today, Singulair is generally considered safe and effective by most physicians, including our own Dr. Little.

Corticosteroids linked to growth stunting. Back in the 1980s my doctors were concerned that systemic steroids to get my asthma under control might stunt my growth. This was a legitimate fear back then. It was so bad that my doctor wouldn’t even let me use my inhaled corticosteroid unless I was having a flare-up. This fear worked to my detriment, as I would have an asthma attack as soon as I stopped taking it.

A 2000 study showed that those who used the inhaled corticosteroid pulmicort were twice as likely to be 1.1 cm shorter than those who used a placebo. The study concluded that the medicine does have a slight (although transient) impact on adult-attained height.

However, most experts now consider daily use of inhaled steroids a top-line method of controlling and preventing asthma. The catch is you have to rinse your mouth out after each puff in order to prevent systemic side effects. Generally, when used correctly, inhaled corticosteroids are considered very safe.

Lessons were learned from each scare. Combination inhalers like Advair, Symbicort, Dulera, and Breo are now recommended as top-line medicines to control and prevent asthma symptoms. These medicines should never be used more than prescribed. When symptoms occur between doses, asthmatics are now instructed to refer to their asthma action plans.

So, asthma medicines are generally considered safe when used as prescribed. The general consensus is that the risks associated with uncontrolled asthma are far greater than the risks of asthma medicines. However, as always, you should be aware of any potential side effects, and notify your physician should you observe them. Do not ever stop taking any asthma medicine without first consulting with your physician.

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