Lung disease experts at Johns Hopkins have advocated for greater caution in prescribing inhaled corticosteroids for COPD (chronic obstructive pulmonary disease) sufferers.

This call for caution came after evidence suggested that inhaled corticosteroids, one of the most widely used anti-inflammatory medications, increase the risk of pneumonia by a full third.

From News-Medical.Net:

“Physicians really need to strongly evaluate a patient’s individual characteristics before prescribing these steroid medications, and patients, in turn, should weigh the risks and benefits of taking the drugs, despite their proven record in providing symptomatic relief,” he says.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, “catching this bacterial infection can seriously disrupt quality of life, making it harder for COPD patients to breathe and possibly leading to hospitalization.”

Drummond says the new findings should serve as a reminder to people with the severe lung disease to take steps that reduce the chance of getting pneumonia, which doubles their risk of dying when compared to people with healthy lungs. He also advises COPD sufferers, in addition to weighing the benefits and harms of steroids, to get the pneumonia vaccination every five years and an annual flu vaccination because these shots reduce the chance of getting a lung infection.

Drummond suggested that people suffering from lung disease must take additional precautions such as frequent hand washing to ensure that they lead a normal and healthy life. It was also remarked that further research is a must for providing greater relief to COPD sufferers.

This study is expected to provide a great relief to existing 120,000 Americans suffering from COPD, which is expected to become the nation’s third leading cause of death in the United States by the year 2020.

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Inhaled corticosteroids are far better than sodium cromoglycate for controlling asthma besides enhancing quality of lung function to a considerable extent, as per a recent study.

It was remarked by Dr James Guevara, Department of Pediatrics at the University Of Pennsylvania School Of Medicine in Philadelphia and lead review author of this study that the untamed superiority of inhaled corticosteroids appears to improve with moderately low doses, as compared to low doses.

From News.Bio-Medicine.org:

Inhaled corticosteroids (ICS) and sodium cromoglycate (SCG) are both used to help people with asthma. SCG is believed to have a low risk of causing long-term side effects, but despite anxieties relating to routine use of steroids, the use of ICS has steadily increased since the 1990s.

While they are both known to work, there has previously been a debate as to whether one is superior to the other.

By pooling data from randomized controlled trials that directly compared the effects of ICS and SCG the Cochrane Review Authors could assess the relative benefits of each. They considered measures of lung function, asthma control and the use of general healthcare services such as GPs and hospitals.

Their conclusion was that ICS controls asthma better than SCG and that it also leads to improved lung function. They were, however, unable to decide whether there were differences in side-effects as most of the trials ran for too short a time to assess long-term outcomes.

“The superiority of ICS over SCG appears to increase when patients use moderate doses of ICS, compared with when low doses of ICS are used,” says lead Review Author Dr James Guevara, who works in the department of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

It was concluded by Dr Guevara that asthma can be effectively controlled by corticosteroids as compared to sodium cromoglycate and can be prescribed by medical practitioners to their patients fighting with asthma.

It is believed that the finding of this study would prove beneficial to approximately one million asthma patients in the United States alone.

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According to a new review of recent studies, a combination of airway-opening drugs and inhaled steroids with inflammation-reducing properties works better when it comes to the prevention of severe asthma attacks than a normal dose of steroids alone.

It was proved, however, that higher doses of steroids prove to be as effective as the combination therapy for preventing asthma attacks as per a second review.

From News-Medical.Net:

Asthma patients who used both LABA medication and an inhaled steroid were significantly less likely to have a severe asthma flare-up requiring treatment with an injected or swallowed steroid than patients taking the steroid alone, according to Muireann Ni Chroinin, M.D., of the Norfolk and Norwich University Hospital in England, and colleagues.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The rate of severe attacks dropped from 27 percent to 22 percent in patients taking the combination therapy. Ni Chroinin and colleagues calculate that 18 patients would need to be treated with LABA for one year to prevent at least one patient from having such an attack.

Jerry Krishnan, M.D., an asthma researcher and assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine, said that he believes that there is a tendency for the initiation of combination therapy with LABAs (long acting beta-2 agonists) and inhaled corticosteroids.

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Lung disease experts at Johns Hopkins have made a call for greater caution for prescribing inhaled corticosteroids to people with COPD (chronic obstructive pulmonary disease). This call was made after evidence was found that the widely used anti-inflammatory medications tend to raise the risk of pneumonia by a full third.

It is believed that more than 11 million Americans are living with COPD and a vast majority of this population belongs to the former or current smokers’ category.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, these new findings are expected to serve as a reminder to all those people with severe lung disease to plan and take steps that can minimize the chances of getting pneumonia, which doubles their risk of dying.

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According to a study that was presented at the American Thoracic Society, there may be occasions when some children may find it difficult to control asthma when they are administered with inhaled corticosteroids, one of the most popular forms of asthma treatment.

The study was quick to highlight that some children may be genetically less responsive to steroids, a fact that was brought into notice by Gregory Sawicki, M.D. of Children’s Hospital in Boston.

From News-Medical.Net:

“The majority of children with mild asthma are less likely to have symptoms as they get older and may not need to be on daily steroids,” Dr. Sawicki said. “The flip side is that if a child has poor asthma control, the parents and doctor need to make sure the child is adhering to their inhaled steroid treatment. But variation in response to inhaled steroids, as other medications, is well described.”

The data comes from the Child Asthma Management Program Continuation Study (CAMPCS), one of the largest groups of children with mild to moderate asthma in the nation who have been followed over 10 years. “This study gives us a good sense of real-world practice in asthma management,” Dr. Sawicki says. “The children’s care is not directed by anyone in the study; it’s an observation of what goes on when the children’s care is directed by their own physicians.”

Dr. Sawicki went on to remark that it had already been communicated in the past that even an extensive use of inhaled steroids may not prove its worth for well-controlled asthma in every adult asthmatic patient. This study is believed to provide a new direction to doctors who have been findings ways to control asthma in their patients with little or no success.

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According to an analysis, asthma patients tend to adhere more to oral controller medications compared to inhaled corticosteroids.

Only 70% of asthmatics report using their inhaled corticosteroid regularly when not having asthma symptoms. According to the study, several reasons were given for non-compliance to inhaled corticosteroid maintenance treatment.

One is the anxiety of potential side effects brought about by inhaled corticosteroids. Another reason cited was the lack of confidence to use inhaled corticosteroid properly. The last reason cited was the difficulty to follow their inhaled corticosteroid treatment plan.

According to the authors, the most effective method of asthma treatment is a combination of inhaled corticosteroids and long-acting beta agonists.

Furthermore, doctors should consider inhaled corticosteroids and long acting beta agonists as their first choice of treatment for asthma patients, when switching from a single drug therapy to a combination therapy. This was even recommended by the National Asthma Education and Prevention Program in 2002 and 2007.

The authors concluded that when patients could not comply with their inhaled corticosteroid treatment plan, the next therapy of choice is a leukotriene modifier.

Leukotriene modifiers help prevent the release of leukotrienes, fatty compounds produced by the immune system which causes inflammation in asthma and bronchitis and causes airways to constrict.

From Medpage Today:

When adherence was not an issue, inhaled corticosteroids reduced the risk of emergency department visits and hospitalization and were associated with lower treatment costs, Hiangkat Tan, of HealthCore in Wilmington, Del., and colleagues reported in the August issue of Mayo Clinic Proceedings.

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According to lung disease experts at Johns Hopkins, there is a great need for caution by physicians in prescribing inhaled corticosteroids for patients with COPD (chronic obstructive pulmonary disease). This finding was revealed after it was found out that anti-inflammatory medications increase the risk of pneumonia by a full third.

It is presently estimated that more than 11 million Americans, most of them former or current smokers, are suffering from COPD that is characterized by the fatal and lung-diminishing conditions of emphysema and chronic bronchitis.

From News-Medical.Net:

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

“Physicians really need to strongly evaluate a patient’s individual characteristics before prescribing these steroid medications, and patients, in turn, should weigh the risks and benefits of taking the drugs, despite their proven record in providing symptomatic relief,” he says.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, “catching this bacterial infection can seriously disrupt quality of life, making it harder for COPD patients to breathe and possibly leading to hospitalization.”

Fan says that COPD is expected to become the third leading cause of death in the United States by 2020, behind heart ailments and cancer and ahead of stroke.

During the study, it was advised that physicians need to exercise a higher sense of caution than what is observed by them nowadays so that inhaled corticosteroids do not pose any danger to health of their patients. For this, patients and their families need to be made aware of the pros and cons of inhaled corticosteroid trearment.

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New findings have been revealed with regard to use of chronic corticosteroid at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle.

According to Rebecca Green, M.D., Ph.D., Assistant Professor, Pediatric Endocrinology and Diabetes, Washington University School of Medicine in St. Louis, Mo., corticosteroids have been considered to be miracle drugs for many ailments when it comes to controlling symptoms where other medications failed to deliver any good results.

From News-Medical.Net:

The side effects attributed to corticosteroids include decreased bone mineral density and reduced bone mass, and also in children, reduced growth rate. According to Dr. Green, strategies to alleviate these effects include minimizing oral doses and adding topical or inhaled steroids to provide the same anti-inflammatory benefit in the areas affected by inflammation while avoiding systemic effects. Disturbance in bone acquisition in childhood can reduce peak bone mass and therefore significantly impact the life time risk of osteoporosis.

“One of the challenges has been distinguishing the effects of the inflammatory process itself on bone mass and growth, and the effects of corticosteroids on bone growth from the effects of corticosteroids on bone mass,” she said.

“Analysis of large population databases has recently yielded extremely valuable data about corticosteroids and fractures, with some unexpected impact of lower doses. Analysis of the same database for inhaled steroid use in adults showed a small increase in fracture risk in users of inhaled steroids compared to control, but comparable risk of fracture in inhaled steroid users compared to individuals using inhaled bronchodilators. This suggests that the increased risk of fracture was secondary to the disease itself, not the inhaled steroids,” Dr. Green explained.

As per Dr. Kelly, Professor Emeritus Of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, N.M., the use of inhaled corticosteroids has the potential for minimizing bone mineral growth in male children who are progressing through the stage of puberty, but the associated risk is more likely to be outweigh by an ability to minimize the quantity of oral corticosteroids used in these children.

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A study claimed that taking inhaled corticosteroids may lower the risk of lung cancer among people with chronic obstructive pulmonary disease (COPD). Inhaled corticosteroids reduce inflammation in the airways thereby improving symptoms associated with the disease.

Researchers said inflammation in the lungs is thought to play an important role in both COPD and lung cancer, and the results suggest that daily use of inhaled corticosteroids may help fight inflammation and prevent the progression from COPD to lung cancer.

From Bio-Medicine:

The study conducted by the University of Washington suggests people who took at least 1,200 micrograms per day of inhaled corticosteroids had a 61% lower risk of developing lung cancer than non-users.

Researchers followed a group of more than 10,000 mostly older male U.S. veterans with COPD who were treated in Veterans Affairs primary care clinics from 1996 to 2001. Of these, 517 were regular users of inhaled corticosteroids as determined by records of pharmacy refills and were included in the study’s analysis.

The results, published in the American Journal of Respiratory and Critical Medicine, suggested that compared with non-users of corticosteroids, those who took 1,200 micrograms or more per day of inhaled corticosteroids were 61% less likely to develop lung cancer.

The researchers note that this is an observational study that “cannot conclude that [inhaled corticosteroids] reduce lung cancer” and that the results need confirmation. They also say no drugs have been clinically proven to prevent lung cancer among those at risk, but several are under investigation.

Previous studies have shown that inhaled corticosteroids reduce markers of inflammation such as C-reactive protein and reduce airway inflammation.

Smoking is a primary cause of COPD, which includes two inflammatory lung diseases that interfere with breathing: chronic bronchitis and emphysema. An estimated 11 million adults suffer from COPD which could lead to lung cancer.

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As per a study by the National Jewish Health researchers, being overweight or obese does not put asthma patients at more risk than their leaner counterparts although obese asthmatic patients may be slower to respond to medications.

According to lead author E. Rand Sutherland, Associate Professor of Medicine at National Jewish Health, an improvement in asthma condition may not necessarily occur from weight loss. It was also remarked by Sutherland that obese asthma patients may not respond that well to inhaled corticosteroids, which are the most successful and popular controller medications for asthma.

From News-Medical.Net:

Dr. Sutherland and his colleagues decided to examine the issue in a well characterized group of 1,256 patients who had participated in NIH-sponsored studies. They divided them into patients with a body mass index of less than 25 (lean) and greater than or equal to 25 (overweight and obese). They found that lean asthma patients had slightly greater forced expiratory volume in one second, or FEV1 (3.05 liters vs 2.91 liters), and slightly greater ratio of FEV1 to forced vital capacity (83.5% vs. 82.4%), both common measures of lung function. They also found slightly greater use of rescue inhalers among overweight patients (1.2 puffs per day vs. 1.1 puffs per day) and slightly higher scores asthma-relate quality of life questionnaires (5.77 vs. 5.59).

“These differences were small and are unlikely to be of any real clinical significance,” said Dr. Sutherland.

Response to medications, however, did show an effect of increased weight. Among a subgroup of 183 people, lean patients taking inhaled corticosteroids alone showed a 55% greater reduction in exhaled nitric oxide, a measure of inflammation. Lean patients taking a combination inhaled steroid and long-acting beta agonist increased their FEV1 by 80 more milliliters. There were no differences, however, between these patients in the number of asthma exacerbations.

“The data suggest overweight and obese people respond less well to controller medications for asthma than do their lean counterparts,” said Dr. Sutherland. “These data come from already-completed studies designed to answer other questions, however, and ongoing studies are being conducted to more definitively determine the effect of increased weight on treatment response in asthma.”

This study however did not reveal a considerable effect of increased weight in relation to the response of asthma medications.

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