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Asthma

Corticosteroids and Bone Loss

05/31/2007

Question:

I am a non-smoking, 40 year old female who eats a healthy diet, exercises regularly, and takes the proper supplements. I was recently diagnosed with osteopenia. I assume this was caused by my 15 year use of inhaled corticosteroids to control my asthma. I take four puffs of AeroBid per day, and one puff of Proventil each day, so my asthma is pretty mild.

A few years ago, I tried Singulair to see if it would potentially decrease the amount of other asthma drugs I needed to take. However, this drug caused me ear pain, which I still have, so I discontinued it and would be cautious of trying another drug in its class.

The osteopenia has me worried and upset:

1. Are there any current drugs, or ones on the horizon, that might replace corticosteroids for asthma control? It seems that minimizing my use of this type of medicine is my best shot at keeping my osteopenia from progressing into osteoporosis...

2. Cincinnati is a maligned allergy/asthma capital. I’m retiring within the decade -- can you recommend any areas that are consistently rated as good for asthma, or what type of climate works best to potentially minimize need for inhalers?

Answer:

Osteopenia (reduced bone density) and osteoporosis (severely reduced bone density) can be caused by steroids like prednisone.  Inhaled steroids used for the treatment of asthma are less likely (than oral steroids) to cause bone loss but can, especially in high doses. 

Other factors that increase your risk of bone density loss includes: family history, race (Caucasian and Asians are at higher risk), low calcium intake, lack of physical activity, cigarette smoking, excessive alcohol intake, low body weight (being thin), low estrogen conditions like menopause.

Prevention is the key!  Staying active, not smoking, avoiding alcohol, eating calcium rich foods totaling more than 1000mg per day are important for prevention.  When you have persistent asthma, inhaled steroids are the drug of choice to reduce inflammation in the airways and keep asthma controlled. 

Ideally you should be on the least amount of medication to keep your asthma controlled.  If your asthma has been stable (no flare-ups) for at least 4-6 months it is reasonable to talk to your doctor about reducing the asthma medication you are on. 

There are several non-steroid drug classes that can be used alone in those with mild persistent asthma or combined with inhaled steroids for those with moderate persistent asthma.  These include: "leukotriene receptor antagonist" like Singulair and Accolate, "mast cell stabilizers", or theophylline.  Talk to your doctor about possible alternatives.

I would encourage those with asthma and other lung diseases who are relocating to review the recently published air quality report by the American Lung Association which includes a list of the 100 worst cities.

For more information:

Go to the Asthma health topic, where you can:

Response by:

Cathy   Benninger, RN, MS, APRN, C-AE Cathy Benninger, RN, MS, APRN, C-AE
Clinical Assistant Professor
Director, OSU Asthma Center Educational Program
College of Medicine
The Ohio State University