With spring – and pollen – in the air in Australia, medical experts are warning against the overuse of asthma inhalers, flagging the potentially toxic effects of unnecessarily high doses.
Asthma can appear at any time in life, and people can develop asthma at age 50, 60 or even later. Those diagnosed with adult-onset asthma will often be prescribed asthma preventer inhalers.
But in an article published in the medical journal Australian Prescriber, Professor Helen Reddel and co-authors Dr Gloria Foxley and Dr Sharon Davis issue a reminder that most of the benefit of asthma preventer inhalers is gained with low doses.
Read: Older Australians at greater asthma risk, women most of all
Despite this, they warn, many Australian patients are prescribed doses of inhaled corticosteroids (ICS) that are higher than necessary.
The consequences of an asthma attack can, of course, be very serious, as seen in the thunderstorm asthma event that affected thousands of Melburnians in 2016. But the long-term effects of the overuse of corticosteroids can also be serious.
Prof. Reddel says that long-term treatment with high doses is associated with a small increase in the risk of conditions including cataracts, osteoporosis, diabetes, weight gain, sleep apnoea, pneumonia, heart failure, stroke and depression. However, as long as the dosage is low, most of the benefits can be achieved with very little risk of adverse effects.
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The problem is, says Prof. Reddel, that, according to a recent study, 71 per cent of Australian adults and adolescents with asthma who were prescribed preventer inhalers had been dispensed a high-dose combination of low-dose ICS with a long-acting beta2 agonist (LABA).
According to Prof. Reddel and her colleagues, only some patients need daily treatment with this combination.
Why are asthma patients being overprescribed?
The reasons for the overprescribing are unclear. Some patients may have been correctly prescribed a high-dose preventer on diagnosis, but that dose hasn’t been reviewed since symptoms improved. Those patients may then remain indefinitely on unnecessarily high doses.
Another possibility is that some clinicians, given the substantial time pressures, feel that switching asthma treatment may not be a worthwhile use of their time, especially if there is a risk that asthma control will be worse after the switch.
Whatever the reason, Prof. Reddel and her colleagues from Sydney’s Woolcock Institute of Medical Research are advocating what they call a ‘step-down’ approach for those whose long-term dosage exceeds recommendations.
Reviews show that preventer treatment can be stepped down safely, with no overall increase in risks.
They say that step-down therapy should be considered when asthma has been well controlled for at least two to three months, particularly if the ICS dose is medium or high.
Read: What you need to know about asthma
What constitutes a high dose varies according to the inhaler used. As an example, for Budesonide (sold under the brand name Pulmicort), a level of 800 micrograms or more is considered high.
Those who are concerned about their dosage levels should consult their GP. Your GP should have an individualised written asthma action plan for you before instituting a step-down program.
With one in nine Australians suffering with asthma, any steps towards reducing dosage should be undertaken with caution but, Prof. Reddel said: “If your asthma has been stable for more than three months, check with your doctor. It may be possible to reduce the dose.”
Are you an asthma sufferer? Do you use a preventative inhaler? Why not share your experience and thoughts in the comments section below?
Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.
My wife and I are in our 70th year. My wife i]has life-long asthma. Prior to age 40 she was prone to occasional asthma attacks, sometimes serious enough to be life-threatening, So doctors put her on Budesonide pump twice daily as a preventative, with ventolin inhaler only if wheezing happens. This approach kept the asthma managed, but no doctor ever suggested reducing the dose.
Now this article reveals a cause of her advanced osteoporosis, which my wife has had since her early 50’s, despite always having good diet and calcium and vitamin D. Doctors have continued do prescribe these asthma treatments without so much as a caution about the effect on osteoporosis. It all reeks of a lack of care and negligence by doctors. Surely a doctor has responsibility to warn patients of risks. And suggest dose reduction ? We feel badly let down and neglected by the medical services especially in the last decade.
I am now 75 and have had asthma since early childhood. I wasn’t officially diagnosed until my early 40s. Back then I was put on a preventer, a tablet called Theodor/Theoder (or something like that) together with Ventolin puffer as required. Later the preventer was changed to Becloforte and then later still to Symbicort, a combination of “budesonide and formoterol;” first in the form of a “turbohaler” and more recently in the form of a puffer, which I am still currently using at 200μg per dose coupled with Ventolin inhaler (a “stopper”) as required. This combination has contributed greatly towards the control of my asthma. I presently live in Ballarat VIC, having moved here in 2013 from Perth W.A. From a considerably warmer to a considerably cooler climate, which impacted on my asthma detrimentally. However, my current treatment has thankfully brought this under control.
I agree with Brian, medical professionals should be doing more in the line of advising their patients on the effects of the medications they are prescribing for them. However, this facet of their treatment is seriously lacking. It seems to me that most GPs really do not know what the medications they’re prescribing do to or for the recipient either pro or con.
Disclaimer: This is merely my own opinion based upon my personal observation and should not be taken as a general statement of fact.