Doctors told: take a breath over puffer doses
The Daily Telegraph, September 16, 2002, by Judy Skatssoon.

Australian doctors have been told to reduce the levels of inhaled steroids they prescribe to treat asthma following reports of deaths and serious side effects overseas.

Inhaled corticosteroids revolutionised the treatment of asthma and have become a mainstay of therapy over the past 20 years because of their powerful anti-inflammatory action and availability on the government subsidy scheme.

But the arrival of more potent steroids over the past two years, along with more effective ways of delivering them, means doses haved increase, an editorial in today’s Medical Journal of Australia warns.

Associate Professor John Wilson from Monash Medical School’s department of Respiratory Medicine said there have been several reports in overseas journals of serious “adverse events” from excessive doses of corticosteroids including “altered consciousness and coma, convulsions and death.”

Professor Wilson said, when used at appropriate levels, inhaled steroids were safe. Asthma death rates in Australia halved in the past 12 years along with the increased use of corticosteroids.

But he said doses should be reduced to appropriate levels to control symptoms while reducing the likelihood of potentially fatal side-effects. “Australian prescribers have used higher doses of inhaled corticosteroids (than their US and European counterparts) but there is now a clear incentive to reverse this trend,” he said.

Research fellow and respiratory doctor Greg King agreed that inhaled steroids should remain a cornerstone of asthma treatment but said doctors needed to be more discriminating about which patients required high doses.

“Inhaled steroids…are the single most important drug in asthma and if used appropriately, most people don’t need big doses,” he said. Dr King said he was unaware of any serious side effects from inhaled steroids reported in Australia.

Asthma Australia CEO Anne Wilson said it was important that people” see their GP… because it’s about monitoring and reviewing their medication”.

Asthma is an inflammatory condition of the air passages which makes them prone to narrowing and increased mucus production, leading to difficulty breathing.

Severe attacks can lead to death.

The disease has increased over recent years and is Australia’s most widespread chronic health problem, with one in four primary school children and one in seven adolescents affected.

Gina Gainsford is familiar with frequent inhaler treatment. She had expected her asthmatic son Samuel, 5 to be wheezing and coughing from the weekend smoke haze over Sydney but, to her distress, it was one-year-old daughter Abbey who had symptoms.

Her husband David also suffers from asthma and Samuel requires a puffer daily.

“It’s a horrendous thing … Samuel’s asthma presents as a really husky cough and Abbey had that hacking cough, which made me think that, because they’re similar, this is it, Abbey has asthma,” she said.

Enhance your child’s immunity chances

· No one gene is a major cause of asthma, although a number of minor genetic factors may combine to increase the risk
· Early exposure to domestic and farm animals appears to reduce the chance of developing asthma
· High levels of hygiene may increase the likelihood of asthma
· Increased exposure to infections in infancy may protect against it
· Avoiding allergens like dust mites does not appear to significantly reduce its development
· Exercise-induced asthma occurs in up to 23 per cent of children, but 40 percent of these have never been diagnosed with asthma
· Nebulisers are not needed for most children with asthma
· Breastfeeding for the first 3-6 months of life and not smoking during pregnancy and infancy can prevent asthma
· Children who eat fish regularly have lower levels, while eating fish during pregnancy seems to protect against it
· If a child’s first episode of wheeze occurs in the first year of life the child has about a 50 per cent chance of developing asthma
· Episodic childhood asthma tends to resolve itself in later years but persistent asthma is more likely to continue, with impairment of lung function

Source: Childhood asthma symposium, Sydney 2002

Another similar report also appeared in the Sydney Morning Herald, dated September 16, 2002. Doctors Warn of Asthma Steroids, by Ruth Pollard.