safety of long term inhaler

[malan]

Dear Sir,
I have been advised to use the fluticasone propionate inhaler to control my asthma. However, as a child ( I am now 50, male), I have been treated for TB. Also, I fear being susceptible to weak bones as well as eye problems like cataract. Is it, therefore, safe to use this inhaler?
Thnx
Malan

[David Tinkelman, M.D.]

There is substantial evidence (several large randomized clinical trials) that inhaled corticosteroid  therapy (ICS) especially high doses (HD), for example, >500 mcg of fluticasone , increases the likelihood of pneumonia.  The administration of  systemic (oral) corticosteroids is a known risk factor for tuberculosis (TB). It has been reported that high dose ICS is associated with the development of pulmonary TB in persons with COPD*   For this reason, it has been recommended that every patient with COPD should undergo chest radiography, sputum acid-fast smear, and mycobacterial culture before receiving, as well as regularly during, HD ICS therapy.  It is suspected, but not proven that this risk would also occur in persons, with a history of TB, who do not have COPD.  In addition, the risk would be greater if you were treated, in childhood, for active TB and not just prophylactically for a positive TB skin test conversion.
My answer to your question, regarding the possibility and magnitude of risk for reactivation, must be a qualified maybe.  Your physician obviously deems it necessary for you to be treated with ICS to gain control of your asthma and that conclusion must be respected.  Optimum control of asthma is of the utmost importance.
My recommendation would be that you and your doctor work closely together to find the lowest dose of fluticasone that will provide good asthma control.  In addition, I recommend that you and your doctor may wish to develop good follow-up, with implementation of the underlined recommendations in the above paragraph.  With good, close monitoring, the risk of your developing undiagnosed reactivation of TB would be very low.   Certainly, if any time during the administration of fluticasone you were to develop new respiratory or systemic (night sweats or fever) symptoms it would be imperative to thoroughly re-assess the status of your lungs, vis a vis TB.
Regarding your question about steroid side effects, the answer is yes; the risk of cataracts and osteoporosis heighten but only with high dose inhaled steroids and, even then, the risk is low.
Good luck

[malan]

Thanks very much doctor for your reply. My asthma seems more under control now, even without the fluticasone inhaler. I shall rely on the asthalin inhaler in case of emergency.
Regards,
Malan