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Inhaled Steroids Most Effective Treatment for Asthma

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WebMD Health News
Reviewed by Gary D. Vogin, MD

May 22, 2001 -- Inhaled steroids are one of the principal treatments for asthma, but some patients try to avoid them. Now new research published in the May 23 issue of The Journal of the American Medical Association confirms that inhaled steroids, either alone or in combination with other medications, remain the most effective treatment for chronic asthma.

Corticosteroids are used in asthma treatment to prevent or reduce airway swelling. These steroids are completely different from the anabolic steroids some athletes use to bulk up their muscles. However, the inhaled steroids used for asthma control sometimes do have harmful side effects such as mouth infections or weight gain. If used for long periods, they may lead to bone loss.

In addition to inhaled steroids, long-acting inhaled bronchodilators such as Serevent are also used to control asthma. Current treatment guidelines recommend these bronchodilators in addition to steroids, but not as the sole medication. However, these guidelines were based on expert opinion, not on clinical trials. Now the clinical trials have been done, and they support the guidelines.

"These studies show you can't use [Serevent] by itself to control asthma," says Gilbert D'Alonzo, DO. "It does give you some control of the disease, but you don't get optimal control. These studies show that even a low daily dose of inhaled steroids, when used in combination with [Serevent], provides better control of the disease." D'Alonzo is a professor of medicine at Temple University School of Medicine, in Philadelphia, Pa.

In one study, 164 people aged 12 to 65 with asthma controlled by a low dose of inhaled steroids either continued to get the steroid, or were switched to Serevent, or given a placebo (an inhaler with just the propellant but no medicine). The researchers, led by Dr. Stephen C. Lazarus, MD from the University of California, San Francisco, found that either steroid treatment or Serevent alone were better than nothing. However, the people who only got Serevent experienced so many treatment failures that the researchers concluded, "our findings indicate that [Serevent] should not be used as [sole therapy] for treatment of persistent asthma."

In the second study, 175 people aged 12 to 65 with poorly-controlled asthma were given an inhaled steroid called triamcinolone. In addition they were given either Serevent or a placebo. For some of them, the amount of inhaled steroids was first cut in half, and then eliminated.

The team of researchers, led by Robert F. Lemanske Jr., MD from the University of Wisconsin Children's Hospital, found that when patients received Serevent, their inhaled steroid dose could be cut in half without any problems. However, if the steroids were completely eliminated, people had trouble breathing and their quality of life decreased.

"There are people who would prefer to avoid inhaled steroids," D'Alonzo says. "This research shows that Serevent really can't be used alone in the management of chronic asthma. Inhaled steroids are highly effective and very safe."

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