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Steroid Inhalers for Asthma Can Weaken Bones

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"The key question is, how do you get the benefit of inhaled steroids with the least amount of risk?" says Thomas Plaut, MD, who reviewed the study for WebMD. "Not everybody needs them. Someone who does a good job of cleaning up their environment and eliminating allergens such as dust, pollen, and animal dander can cut their need for inhaled steroids by up to 50%."

He says people with mild asthma -- about 60% of all asthma patients -- can often get relief by using instead a medication that doesn't contain steroids to relieve inflammation, such as Accolate, Singulair, or Tilade. However, for many patients, particularly those with moderate or severe asthma, that will not be sufficient. Plaut is the author of Dr. Tom Plaut's Asthma Guide. He is in private practice in Amherst, Mass., and acts as a consultant on asthma issues to health plans and state and municipal health departments.

"Our study suggests that ... patients should therefore take the lowest dose that adequately controls their asthma," the authors write.

Plaut also strongly recommends the use of a spacer, which is a device that attaches to the inhaler. A spacer catches the large particles of steroids and lets you breathe in only the small particles. The large particles are what lead to most of the side effects, but do not add any benefit, Plaut says. "Be sure to rinse your mouth and spit out so you don't swallow any of the medication. Inhaled steroids in the mouth promote yeast infections there and also disperse steroids throughout the body."

Patients with asthma should be aware that they are at increased risk for osteoporosis and therefore take the steps that are generally advised to build and maintain strong bones. Plaut advises all his female asthma patients to take 1,500 milligrams of calcium and 400 units of vitamin D every day. Edelman notes that the need to build and maintain strong bones is yet another reason, in addition to its heart and muscle benefits, to recommend exercise for asthma patients.

"However, since exercise itself can sometimes cause airway narrowing, patients with asthma should engage in the right kind of exercise: walking rather than sprinting. You don't want intensely aerobic games like soccer. Swimming is particularly beneficial for asthmatics, because it takes place in a humid environment, so the airways don't dry out."

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