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Wednesday, May 22, 2013
What Happens if You Don`t Comply?
I am almost 60 years old and have had mild asthma since childhood.
Over the years there have been many changes in the recommended treatment for asthma. Some of those have been welcome and some less so.
The recommendation for inhaled steroids USED to be to use them as little as possible, and only when an exacerbation got very bad and wouldn`t subside on its own. They were considered bad for your health in general. Then the recommendation changed, so that they started recommending daily inhaled steroids all the time, year round.
I never warmed up to that recommendation and never really followed it.
Now my (new) dr is telling me that I have probably already destroyed my lungs by not taking daily inhaled steroids. She said that I have probably created scar tissue that will never go away.
Am I really doomed? Is that what really happens if you don`t take daily inhaled steroids for your whole life, or is she just trying to bawl me out and scare me?
There is a very small percentage of patients with asthma that develop fixed, irreversible obstruction, but the vast majority do not, and we have no data that treatment with inhaled corticosteroids prevents that. Therefore, treatment of asthma is based solely on control of symptoms (cough, wheezing, nocturnal awakenings with cough or wheezing, and exercise limitation).
If a patient is experiencing weekly symptoms, they should take a daily preventative medicine and use albuterol as needed. The best preventative medications are the inhaled corticosteroids although the leukotriene inhibitors (singulair) are an alternative. We generally don't worry much about low dose inhaled steroids and osteoporosis.
Jeff E Weiland, MD
Associate Professor - Clinical
OSU Asthma Center
College of Medicine
The Ohio State University