Posts Tagged ‘last resort’

Steroid inhalers
Most asthmatics nowadays are given a steroid inhaler at some point, as part of their asthma treatment (see p. 160). It will probably be a low-dose inhaler, and the risks of side effects from this are very small. Even at higher doses, inhaled steroids are relatively safe. Many people are unnecessarily afraid of inhaled steroids and refuse to use them until their asthma becomes really incapacitating. It is important not to delay using an inhaled steroid for too long, as this could cause permanent damage to the airways: inflammation eventually thickens the airway wall, leaving it less flexible and therefore less capable of widening.
For side effects of inhaled steroids see p. 145, and for common brand names see p. 147.
Steroid tablets
These are usually a treatment of last resort. But when you need them you need them – and if your asthma has got badly out of control, they can, quite literally, be a life-saver. On the other hand, if there are any other means by which you can tackle your asthma, so that you do not need steroid tablets again in the future –avoiding allergens and irritants, for example, or using other preventer treatments – those means should definitely be taken.
For side effects of steroid tablets see pp. 141-3, and for common brand names see p. 147.
Cromoglycate-type drugs
For asthma, these drugs are taken by inhalation only. They work by blocking the allergic reaction (see p. 148), and are therefore a type of preventer drug.
Cromoglycate-type drugs are usually inhaled four times a day, although your doctor may recommend more frequent inhalations to begin with. Once your asthma is well controlled, you may be able to reduce the dosing regime to three times a day, or possibly twice a day: ask your doctor’s advice about this.
Should you decide to stop taking these drugs at some point, talk to your doctor first. It is generally best to reduce the dose gradually, over a period of 7-10 days. Some asthmatics need to introduce (or reintroduce) steroids at this time, to maintain control of the airway inflammation.
Side effects
When inhaled, cromoglycate-type drugs can produce short-lived irritation in the throat, which may lead to coughing. This sometimes develops into temporary bronchospasm, causing you to wheeze, but this is really only a minor side effect – it does not indicate that the drug is making your asthma worse.
Asthmatics are sometimes advised to use a short-acting
beta-2 reliever (such as Ventolin) before their cromoglycate inhaler, to overcome this problem. However, this would involve using the beta-2 reliever four times a day, which is no longer considered a good idea (see pp. 153-4). Talk to your doctor again if you have been given this advice.
Inhalers that combine sodium cromoglycate with a short-acting beta-2 reliever (e.g. Aerocrom) are not recommended for the same reason.
A better way around the problem of throat irritation may be to switch to an aerosol inhaler, because the irritation is much less than with dry-powder inhalers. Using a spacer along with the aerosol inhaler (see p. 162) will help even more.
Serious side effects of these drugs are very rare (see p. 149). For common brand names, see p. 148.