Risks Associated With Combining Oral and Nasal Inhalants

Thursday, July 23, 2009, 12:28
Asthma
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Have there been any studies or does anyone know whether there is any additive effect or even synergistic effect if you are on both oral and nasal steroid inhalants? Like how great would the risk of glaucoma become, for example?
Dr. Stempel:: First off, I think you’re talking about an article that appeared in one of the medical journals, JAMA. And it said that there was a slight increased risk of glaucoma with the use of inhaled corticosteroids. And I think there were a couple of very important things to think about when you read through the article. One is, does it apply to most patients or just to a very few, and what levels of medicines are necessary?First off, in the article it only applied if you used very high doses of an inhaled corticosteroid for your lungs. It didn’t apply if you used inhaled corticosteroid for your nose. So the big problem was high doses and what they were talking about with Azmacort might be above 16 sprays a day of the inhaler and with a medicine like Beclomethasone, it might even be 20 or 30 sprays. So very high doses. Most people aren’t on it. But those people who are on those high doses of inhaled steroid are on those instead of being on Prednisone. The alternative would be Prednisone, which we know causes more problems. So it is something where you always want to be on enough medicine to keep the symptoms under good control, be able to breathe, and always feel free to discuss with your doctor whether or not it’s time to cut back on medicines if you’re on very high doses.

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