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Seniors and Asthma
Asthma Drugs and Osteoporosis:
what are the risks and benefits? Physicians operate by the dictum "Above All Else, Do No Harm." While this seems simple, the complexity of modern medicine leads physicians and patients to weigh the risks and benefits of treatment options, rather than make black and white decisions. Such is the case with one class of asthma medications: inhaled corticosteroids (ICS). On the one hand, corticosteroids are known to contribute to the development of osteoporosis (a condition leading to brittle bones), which is a common problem for older patients, especially women. On the other hand, ICS are the most effective class of drugs in the treatment of asthma. Fortunately, when used with care, most patients can use ICS medications without much concern for added risk of osteoporosis. This article will discuss the risks of osteoporosis with ICS and ways to avoid this complication. Physicians worry that ICS may contribute to osteoporosis because oral and injected steroids are well-known to contribute to this process. It is important to remember, however, that ICS, which are inhaled into the lungs and are not swallowed or injected, are concentrated in the lungs. Therefore, only very small quantities of ICS enter the bloodstream and have the opportunity to contribute to osteoporosis. Furthermore, most evidence from research studies shows that ICS, especially newer types, are not associated with increased risk of osteoporosis. However, as with any other medication, only the minimum dose that is required to obtain the desired effect should be used. Your physician will help you to determine the lowest dose of ICS you can take to control your asthma while minimizing the risk of osteoporosis. With all this concern about osteoporosis, you may ask "why should I take ICS at all for my asthma if it may put me at risk for side-effects?" The reason why ICS are so important for the management of asthma is that they are the most effective class of medication to control asthma. If your asthma is uncontrolled, you may have a number of important problems. For example, you may be much less active, may sleep poorly, and may be at risk for hospitalization or even fatality. Incidentally, it is important to remember that reduced levels of activity (due to uncontrolled asthma or any other cause) may contribute to osteoporosis. Therefore, ICS is important in the treatment of many people with asthma to best control their asthma and to prevent complications associated with it. Even though osteoporosis is thought to generally not be associated with judicious use of ICS, and even though ICS is very important to the care of asthma, it is important to remember that osteoporosis is a serious problem that can lead to bone fractures, decreased mobility, chronic pain, and surgeries. Therefore, if you are taking steroid-based medications, it is important that you discuss osteoporosis with your physician, especially if you are a senior. Your physician will weigh risks of osteoporosis with risks of asthma, may prescribe medications to counteract osteoporosis, and may order bone density testing. Your physician will also suggest things you can do to reduce your risk of osteoporosis. Regular exercise and dietary supplementation with calcium and vitamin D, for example, are good ways to reduce the risk for osteoporosis. Exercise is also a proven way to improve asthma. Please discuss exercise and diet with you physician before you make big changes, so your physician can help create a program that is safe and effective for you. Asthma and osteoporosis are both important problems that affect many people. In partnership with your physician, you can take steps to effectively manage both concerns. If you have not been seen by an allergist for these concerns, it may benefit you, since allergists have extensive training in the management of asthma and in minimizing the side-effects of medications, such as inhaled corticosteroids. Brian A. Smart, MD, FAAAAI, is a Fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI) and a practicing allergist/immunologist at DuPage Medical Group in Glen Ellyn, IL. |
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© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
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