Warning for pill-popping asthmatics
NCD CornerSunday, May 30, 2021
BY CHLOE PIPER
ASTHMATICS are being urged to refrain from using oral steroids, such as prednisone, as their first line of treatment, because the long-term effects outweigh the short-term relief.
Speaking to the Jamaica Observer in an interview recently, consultant physician and pulmonologist Dr Althea Aquart-Stewart said many asthmatics are not disciplined enough to use their controller medication and would rather take a prednisone pill, which is an oral corticosteroid.
“A main problem we have in Jamaica is the persistent popping of prednisone steroids. These decrease inflammation and help them to breathe better, [but] this will eventually cause problems as you can become diabetic [if used excessively], gain weight and be hypertensive. So you will get the short-term relief but not the long-term benefits,” she pointed out.
President of the Pharmaceutical Society of Jamaica Dr Winsome Christie and otolaryngologist Dr Andre Crosby have echoed the pulmonologist's views.
The National Health Fund (NHF), which has a card programme that provides subsidies to “every person living in Jamaica at any age for the treatment of 17 chronic illnesses”, defines asthma as a condition that affects the airways, which are the small tubes that carry air in and out of the lungs. The number of individuals enrolled for asthma on the NHF Card Programme as of May 1, 2021 is 80,052.
According to the NHF, people with asthma have airways that are almost always red and sensitive (inflamed). These airways can react badly when you have a cold or other viral infection or when you come into contact with an asthma trigger, it continued.
Dr Christie told Your Health Your Wealth that the first-line treatments for asthmatics are the inhalers, starting with Ventolin, which are the rescue inhalers.
“So, for example, if you have an immediate attack, those type [of] inhalers will work the fastest. You can also maintain and prevent attacks by using the inhaled corticosteroids [controller medication]. If you have an uncontrolled asthma with acute exacerbation, meaning it's always affecting the person, then you have a short course of the oral corticosteroids,” Dr Christie explained, adding that it depends on the person's level of asthma.
“[Oral corticosteroid] is not [used] if you have infrequent asthma or an attack twice a month or more, it's when you have uncontrolled asthma or acute symptoms that occur more frequently, then you will add the oral steroids with the inhaler,” she added, driving home the point that oral steroids are used in more serious cases.
The president of the Pharmaceutical Society of Jamaica explained that prednisone disrupts the hormonal system.
“In fact, that's why you end up with diabetes and hypertension, because corticosteroids are really hormones, so it will affect your adrenal glands function — which are the glands that help with the [body's] production of hormones — because the hormones we actually have [in the body] are steroids in structure.
“It [also] affects the hypothalamus-pituitary axis, which is the major axis in the body that controls hormone secretion — every single hormone in your body,” she continued. “It is very serious, so you don't stop taking it [suddenly], and you don't keep people on it for a very long time. If you take it for a long time, it will suppress your immune system, making you vulnerable to infections.”
Dr Crosby, who pointed out that other side effects associated with Prednisone are muscle weakness, cataract, and cushingoid appearance — also referred to as moon face syndrome — where the person's face has become swollen and round, explained that Prednisone is absorbed into the body, unlike inhaled steroids that go straight to the lungs. He said because of the long-term effects, the recommended prescription for the drug is for five to 10 days.
“Recommended dosage is dependent on the age but, generally, it is 2mg per kg daily for five days. Also, because the half-life is so short, it is rare for you to be addicted [to it], as it stays in the body for 18 to 36 hours,” he said.
Dr Christie explained that there is also a prescribed way of taking prednisone called a 'tapered dose'. The patient will start with a high dose and gradually reduce the daily intake until he or she is on a maintenance low dose, and then they will eventually stop taking it.
She said that, as a clinician or doctor, the main goal is to save lives and ensure the patient gets better as quickly as possible, so he or she may not go through all the management guidelines to determine the type of treatment and as such will provide the steroid for a short period.
“I have seen them do that for paediatric patients because the lung function of a child is much more different from an adult. So to ensure that everything has gotten under control quickly, they might give them a two- or three-day supply of the oral Prednisone or the liquid form, give them the inhaled salbutamol and the inhaled corticosteroid, just to ensure all of that inflammation goes away. The clinician uses their judgement so the guidelines are only a guide… When the patient presents to you, you have to use your judgement,” she said.
To control their asthma, Dr Christie suggests that asthmatics conduct proper inhaler techniques.
“What I find is if the person is taught the proper inhaler techniques by the pharmacist when they come, they don't necessarily have to progress to uncontrolled [asthma]. Sometimes, the person becomes uncontrolled because they are not using the inhaled steroids or inhaled rescue inhaler properly. So, many times, you have to intervene as a pharmacist to teach them how to use it,” the president said.
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