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Steroid Inhalers for Asthma Can Weaken Bones


"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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  • Researchers report patients who took high doses of inhaled steroids for their asthma may be weakening and thinning their bones.
  • Observers note the study demonstrates that loss of bone density is a risk that needs to be weighed before patients start using inhaled steroids to control asthma. Patients also should be talking with their doctors about protecting their bones.
  • The authors stress that patients should take the lowest dose that controls their asthma. Another doctor urges patients to use a spacer, which attaches to an inhaler and catches the large steroid particles so only the smaller ones are inhaled. Large particles don't add benefit to therapy and tend to cause side effects.

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