Asthma Treatment

[RXA]

Hi, I am a 23 year old male, and moved to the United States from another country about 3 years ago. I have had asthma since very young. Anyway, when I was around 13 my doctor in my home country gave me prednisone (plus albuterol, and nothing else). I wasnt put on a regular dose, but was asked to take 5 mg of pred in times I got a serious attack (emergency care often takes upto 45 minutes to get to). From the time I was 13 until about 17 years of age, I needed the 5 mg pred maybe 2-3 times a year. Those 2-3 pills a year dramatically improved my life. AFter I turned 17, even though attacks didnt worsen in frequency or severity, my doctor permitted me to take a dose of upto 10 mg during attacks (again I didnt need to take the single dose more than 3-4 times a year). I was told that a plan like this should not cause any serious effects that are typically encountered with longer treatment plans of pred.

Anyway, after I moved to the States, my doctor told me that I shouldnt be taking any pred at all, and put me on Advair.  

However, whenever I go back to my country, I get a refill on my pred, and continue to use around 10mg about 4 times a year.

Is my situation something I should be worried about?

[National Jewish]

With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs.  Advair™ Diskus® (fluticasone/salmeterol) is a combination of

· an inhaled steroid called Flovent® (fluticasone propionate) that decreases the inflammation in the airways of the lungs when used every day; and

· a long-acting inhaled bronchodilator called Serevent® (salmeterol xinafoate) that prevents the tightening of the smooth muscle around the airways of the lungs when used every day.

There is much less risk of side effects from an inhaled steroid, so this is a good option instead of taking oral steroids, like prednisone.  In the long run oral steroids are harder on your body than inhaled steroids.



Bronchospasm is the tightening of the smooth muscles that surround the airways of the lungs.  A fast-acting inhaled bronchodilator medicine, like albuterol, reverses the bronchospasm quickly by relaxing the smooth muscles.  It is most important that the inflammation and your asthma be under good control.  If you need to use a fast-acting inhaled bronchodilator medicine more than twice in a week this means that the inflammation and your asthma are not controlled.

[starion]

Most US docs I am familiar with prefer that patients who need prednisone several times/year be on maintenance inhaled steroids instead.  The side effects of inhaled steroids are generally MUCH milder than even the few doses of oral steroids you mention and it helps prevent severe attacks, which could require emergency or urgent care.



You should speak with your doctors about thet differences in medication and work with them to develop a plan that helps you have good, stable lung function with few or no flare ups.

Starion