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INHALED CORTICOSTERIODS - a patient's guide
Natalie Gauld - Pharmacy Educator
Contains Beclomethasone, Budesonide or Fluticasone.
These medicines are all corticosteroids.
Beclomethasone is the medicine in Becotide, Respocort,
Becodisk and Becloforte.
Budesonide is the medicine in Pulmicort.
Fluticasone is the medicine in Flixotide.
There are several different devices to help these medicines
get into the lungs.
Metered dose inhalers - you need to co-ordinate breathing
in with pressing the inhaler. Always shake before use.
Breath activated inhalers - like the metered dose inhaler
but when you breathe in the inhaler is activated, releasing
the dose. Always shake before use.
Turbohalers - dry powder in an inhaler device, you twist
the bottom of the turbuhaler to get the dose ready to inhale.
Diskhalers and Accuhalers also contain dry powder in individual
doses. You need to pierce the foil using the diskhaler or
accuhaler then the powder is ready for breathing in.
All the devices work well. Find the one that is easiest
for you to use. Watch yourself in the mirror to make sure
your airways are straight so the medicine will get to the
lungs. Do not hunch over when you are using them.
USE: To make the breathing passages less reactive.
In asthma the airways are over-reactive. They can over-react
to stress, sudden cold air, exercise, pollen, other allergens
or infection. In these cases the airways can become inflamed
and swollen ,triggering changes which mean that the air
has less room to pass through, making breathing more difficult
and causing coughing or wheezing. See Asthma article for
more details.
Corticosteroids (also called steroids) settle down the
breathing passages. They reduce inflammation and make the
breathing passages less reactive, so that asthma attacks,
coughing and wheezing happen less often.
These medicines need to be used every day to keep the
airways in good order. They do not have their best effect
the first time they are used, they need to be used for a
few days or more to work, and in fact they work their best
after a few weeks or more of being used every day. So, most
asthmatics will use them every day all year around to always
get the best effect from them.
Does every asthmatic need to use steroid inhalers?
No, not every asthmatic will need to use these. Your doctor
is best to guide you on this. People with very mild asthma
will often only use a reliever inhaler (e.g. Ventolin) in
the rare times they have wheezing or shortness of breath,
and do not need a steroid inhaler as well. However, for
anyone who uses their reliever more than a couple of times
a week, a steroid inhaler is often recommended.
How do I know if I need a steroid inhaler?
Talk about steroid inhalers with your doctor, and use
his or her guidance. Steroid inhalers are often recommended
for anyone using their reliever (e.g. Ventolin) more than
a couple of times a week. People who have more severe and
persistent symptoms are more likely to benefit from an inhaled
steroid.
Can I use my steroid inhaler like a reliever?
Steroid inhalers do not open the airways in a hurry like
relievers do. They are not used when you are having an asthma
attack to help the breathing quickly. Their effect takes
longer to build up.
Will my child be short if he uses steroids?
Most children who have asthma and are on steroids by inhaler
will not be any shorter than other kids their age. But a
study in the British Medical Journal in February 1998 found
that children with very bad asthma requiring hospital treatment
and high doses of inhaled steroids have been found to have
slower growth. It isn't known if they grew a little slower
because of the high doses of steroids or because of the
asthma being so bad.
In standard and lower doses,inhaled steroids appear to
be very safe to use in childhood asthma. Their use and benefit
needs to be balanced against the risks of untreated moderate
and severe asthma .
Will I get acne or get a deep voice by using inhaled
steroids for asthma?
These steroids are different to the anabolic steroids
used by body builders. Inhaled steroids for asthma do not
cause male hormone effects such as acne, deep voice or muscle
growth.
What side effects do inhaled steroids cause?
Having the steroids go directly into the lungs using an
inhaler, accuhaler or diskhaler means that a lot less steroid
goes around the rest of the body than if the steroid is
taken in a tablet. This means that systemic side effects
of inhaled steroids are not a problem for most people.
If systemic effects do occur,they are usually from very
high doses of inhaled steroids.(higher than average prescribed
dosages).
Side effects are not common with inhaled steroids. In
virtually all cases the benefit of inhaled steroids are
far greater than any problems with side effects.
Some side effects include:
Irritation of the throat, tongue and mouth
Coughing and husky voice
Dry mouth and thirst
Bad taste
Candida infection in the mouth or throat (rinse your mouth
with water after using the inhaler and this shouldn't happen).
The following side effects are even less common, particularly
at the usual doses:
Headache, light-headedness, stomach upset and tiredness
Nervousness or restlessness
Slower growth in children (high doses only)
Bones become less dense
Adrenal suppression
Allergy
Cataract, glaucoma
In very rare cases using an inhaled steroid can cause
a wheeze straight after taking a dose. Stop using and talk
to your doctor immediately.
There may be other side effects, so if you have any unexpected
symptoms while taking this medicine, tell your doctor or
pharmacist.
What will happen if I stop using my steroid inhaler?
Sometimes your asthma will stay the same for a while then
it may gradually get worse. Or it may get worse quickly.
If you are thinking of stopping the steroid inhaler, discuss
it with your doctor first - he/she will know how bad your
asthma is and will be able to advise you.
Once I am on inhaled steroids will I always have to
take them?
This depends on your asthma. There is a trend to slowly
reduce the dosage as far as possible,once asthma is well
stabilised, as long as symptoms remain well controlled.
Examples of when people might stop using the steroid inhaler
are:
Those with very mild asthma that just had a bad patch
- e.g. a bad winter.
Children may grow out of their asthma and no longer need
the steroid inhalers.
Some people with lung diseases other than asthma (e.g.
emphysema) may find that the steroid inhaler doesn't help
their lungs, so there is no point staying on it.
Someone who moves town and finds that their asthma improves
In all cases stopping using an inhaled steroid should
only be done in consultation with your doctor.
Why can't I just use the steroid inhaler if I have
an attack?
The steroid inhaler takes time to get to best effect.
If you wait until you have an attack it will not work as
quickly or as well as if you used the inhaler regularly
before the attack - and the steroid inhaler may have prevented
that attack.
Should I use more of my inhaled steroid if my asthma gets
worse, e.g. if I have a cold?
It is common to use more puffs of your steroid inhaler
during a bad patch. Your doctor should be able to help you
with an action plan. Using a peak flow meter regularly means
you know how your asthma is and the action plan tells you
what to do when your asthma worsens. Only change your dose
according to your doctor's instructions.
Will inhaled steroids help emphysema?
Sometimes inhaled steroids help chronic obstructive pulmonary
disease (COPD), and sometimes they do not, depending on
your lung condition. Often these medicines are tried and
if they are doing any good, great, if not they are stopped.
Will inhaled steroids make my lungs weaker?
No, inhaled steroids will make your asthma better controlled,
so you will feel better. They do not have any bad effects
on the lungs.
How do I know if my inhaler is nearly empty?
You can usually take the canister out and put it into
a bowl of water. If it floats it is nearly empty.
Can I get addicted to steroid inhalers?
No, you do not get addicted to steroid inhalers. However,
do not stop using them without talking to your doctor first.
Can I use inhaled steroids in competitive sport?
The International Olympic Committee requires that corticosteroids
used by inhalation is reported in writing by a doctor. They
can be used in this case.
Interactions:
Fluticasone may interact with medicines such as ketoconazole
(Nizoral) and ritonavir (Norvir).
Patient information:
Follow the instructions on the label of the medicine or
as directed by your doctor.
Use your inhaled steroids every day even when you are
feeling well.
See your doctor if you are using the reliever more often
than usual because your asthma may be going through a bad
patch and your doctor may need to alter your medicine.
Talk to your doctor about action plans and peak flow meters.
Both of these can help very much with your asthma control.
See information on spacers : spacers can help the medicine
get to your lungs more effectively and reduce the amount
of the steroids in the mouth.
Rinse your mouth out, or brush your teeth after using
the inhaler. This prevents a candida infection in the mouth.
If you get white patches in the mouth that can be sore
it may be candida and will need treatment
Don't run out of this medicine, you should be taking it
every day.
If using a metered dose inhaler, shake it well before
use.
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