Reasons for Not Taking Asthma Medications
- Tuesday, September 8, 2009, 23:06
- Asthma
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- Andrew:
- We hear of people dying from asthma attacks, of being hospitalized and of having to make trips to the emergency room in the middle of the night. From your experience, why don’t people keep their asthma under control?
- Dr. Nathan:
- The number one reason is that they fail to comply with their medication. They feel that because they lack symptoms, they no longer have to take their medication, so they just plain stop. What they don’t realize is that once you stop a controller drug, the effects go away very rapidly. Some drugs have more of what we call forgiveness, meaning you can be off of them for a more prolonged period of time without a return of symptoms. Other drugs have a very short forgiveness period. But we know from clinical trials the effects of the drugs after you stop taking them-we know the symptoms basically return within three to seven days, especially when we talk about stopping anti-inflammatory medication or long-acting bronchodilators.
- Andrew:
- Are there any side effects that would make people hesitate to use their controller medications?
- Dr. Nathan:
- Sure. The number one reason patients don’t follow through with their inhaled steroids is probably because of the side effects. Steroid phobia has existed for years, and we know that if you use systemic steroids, oral steroids, or steroids that get injected frequently into your body – they will predispose people to glaucoma, cataracts, osteoporosis, thinning of the skin, even some metabolic changes like diabetes, and possibly even hypertension. That’s a major issue with a lot of patients, but we know now that we don’t require high doses of steroids to control 99 percent of our patients.
- Andrew:
- The truth is, these drugs are improving your airway in a silent way. In other words, if you’re feeling good and you’re taking them, things probably are good. If you weren’t taking them, you might feel good for a little while, but that would eventually go downhill.
“If patients have two different drugs, they’ll stick with the one that gives them relief and stop the one that they don’t feel an immediate benefit from.”
- Dr. Nathan:
- Yeah, that’s one of the big issues– when you take an inhaled steroid, you don’t feel anything. You don’t get the immediate relief that you get when you use your rescue inhaler. That’s why patients commonly stop using their controller drug, especially their inhaled steroids, because there’s no immediate benefit. But they have to be educated to know that the benefit of the drug is long-term – that as long as they stay on it, they will continue to feel good. Once they stop it, their symptoms will return. This brings up a new drug called Advair. Now Advair is a combination of fluticasone, or Flovent, and salmeterol, or Serevent, put together in a device called a diskus – a breath-actuated device. And the reason this is going to be beneficial to patients is that when they use this, they get the immediate bronchodilating effect from the Serevent. Even though it’s a long-acting bronchodilator, meaning it works for up to 12 hours, it has an onset of an effect somewhere between 15 and 25 minutes.
So patients will actually feel something, and they’ll continue to use it because they feel something. Because the anti-inflammatory drug Flovent is in this device, you can’t separate the two. In other words, you’ll stay with both drugs at the same time.
- Andrew:
- If I understand you, the problem, at least with the inhaled corticosteroids, was you didn’t feel the benefit even though it was giving benefit. By combining it with this other type of medication, which is important for control and helps you feel a little better, it puts it all together and may help improve compliance.
- Dr. Nathan:
- Absolutely!
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