Stephen Lazarus, MD
Stephen Lazarus, MD, professor of medicine at University of California, San Francisco, and director of the university’s training program in pulmonary and critical care medicine. UCSFHealth.org
Doctors often instruct patients suffering from mild persistent asthma to use a steroid inhaler every day—but nearly half of those patients receive no noticeable benefit from doing so, according to a recent study published in The New England Journal of Medicine.
The study divided asthmatics into two groups—those who had high levels of a type of white blood cell called eosinophils in their sputum (phlegm) and those who did not. High levels of eosinophils are an indicator of a specific type of inflammation, and for patients suffering from this inflammation, the study confirmed that daily steroid use is beneficial. But 73% of the mild persistent asthma sufferers who participated in the study did not have indications of this type of inflammation—and for two-thirds of this larger group, daily steroid use was no more effective than a placebo. What’s more, daily steroid use is expensive and can have adverse side effects—including increased risk for bone loss, cataracts and glaucoma.
If a daily steroid is not providing any noticeable improvement, ask your health-care provider…
“Can you confirm I’m using my inhaler properly?” Improper inhaler use is more common than people realize. If this fails to solve the problem, ask…
“Is it worth trying a different treatment option, such as a long-acting muscarinic antagonist (LAMA)?” LAMA is traditionally used for COPD. A LAMA inhaler can be effective for some asthma sufferers, with few side effects (notably, dry mouth). Note: As yet, there is no easy and accurate way to test eosinophil levels—you may just have to try a LAMA and see if it works.