— Samantha, New Jersey Yes, there are other options for you. Before I discuss them, let’s just review the effects of the albuterol you mentioned. Albuterol is a symptom reliever. It relaxes and opens the airways and works within a few minutes to relieve chest tightness and that dry asthma cough. Albuterol does not treat the inflammation in the lung linings that actually causes the symptoms of asthma, and it does not help prevent symptoms. If you can’t tolerate albuterol for some reason, then there are several other medications that you could try. If people have asthma symptoms more than a couple of times a week, or a couple of nights a month, then they should receive a “controller medication.” The recommended type to start with is a steroid inhaler (also called inhaled corticosteroid or inhaled glucocorticoid). Specific medications in this group include (in no particular order) Flovent, Pulmicort, QVAR, Asmanex, and many others, both brand-name and generic. These are medicines that are similar to prednisone, but the dose is much lower than prednisone taken by mouth, and the side effects are dramatically reduced. Inhaled corticosteroids work because the medicine is delivered directly to the lung. Another type of controller medication, which is different from either albuterol or steroids, are the pills for asthma, Accolate (zafirlukast) and Singulair (montelukast). These medications are taken orally each day, and treat inflammation in the lungs. They are usually given to people who need a little more treatment beyond a steroid inhaler. These medicines do not have the side effects of prednisone, and they are generally not as strong as prednisone either. But they work well for some people. Please talk to your PCP about trying something to control your asthma symptoms. You certainly do have options. Q2. A week or 10 days of small doses of prednisone is like a magic bullet. All asthma symptoms completely disappear, only to return gradually after a month or so. What is implied when asthma symptoms are so responsive to prednisone - does it mean that the symptoms are more allergy-based? I don’t manifest allergic symptoms like runny nose or itchiness. My symptoms are more classically asthma-like. Would that prednisone were not so generally ill-advised! Prednisone is an extremely effective anti-inflammatory medicine and, fortunately, anti-inflammatory treatment works for you. Since the source of your inflammation is unclear, allergy evaluation with skin testing seems warranted. A combination of inhaled steroids and antihistamines (drugs that block the action of histamines, which can cause itching, sneezing and watery eyes) or antileukotrienes (medications that inhibit the action of substances called leukotrienes, which trigger asthma symptoms) will probably be extremely effective for you and reduce the need for oral steroids. Q3. I cannot live without prednisone. How harmful to my body is this? I have tried every new asthma medication on the market. Nothing works for long. Only prednisone works. I am sure that there will be long-term effects on my body. I have already been diagnosed with diabetes and high blood pressure. I was told the prednisone was the cause. Will prednisone eventually kill me? Prednisone is an extremely effective anti-inflammatory medicine. Unfortunately, there are many side effects associated with it, the most common being osteoporosis, or weakening of the bones. Diabetes and hypertension, as you’ve already discovered, unfortunately, are two other serious side effects. Prolonged steroid use also puts you at increased risk for cataracts, glaucoma, fluid retention, frequent infections, weight gain, skin problems, and mood disorders. Oral steroids like prednisone should only be used as maintenance medication in the most severe cases of asthma. There are many excellent treatments for asthma, including a variety of inhaled steroids, which are the cornerstone of modern asthma therapy. You say you’ve tried them all, but perhaps there are combinations of medications you haven’t tried yet. Keep working with your asthma specialist. It would be prudent for you to be re-evaluated to see if a combination of the existing remedies helps with your symptoms and allows you to cut back on the prednisone. You may also benefit by working with an allergist to identify potential asthma triggers, both inside and outside the home. A careful examination of your living and working environments may be in order, once you know more about allergens. Many asthma triggers can be eliminated or avoided, and in your case this would be time and effort well spent. Q4. I have chronic severe asthma and I have attacks every morning. I have recently stopped taking high doses of prednisone, which I took for 14 years straight. I do not want to take prednisone anymore. I want to know how to prevent these really scary attacks - any ideas? You should follow up with your physician so that he or she can discuss with you the numerous asthma controller medications such as inhaled corticosteroids, long-acting bronchodilators, leukotriene modifiers, mast cell stabilizers, methylxanthines, anti-IgE therapy (if appropriate) and possibly others that are currently available and will hopefully eliminate or at least minimize your need for prednisone. Learn more in the Everyday Health Asthma Center.
