Doctor's Warning on Steroidal Inhalers

Currently, steroidal inhalers are a standard treatment for asthma in children. Yet a study in The New England Journal of Medicine Reported that these drugs have no long-term impact on the progression of asthma or on lung function in preschoolers.

While symptoms were controlled during treatment, benefits disappeared when treatment was halted. Additionally, steroids have many dangerous side effects, with children in the study experiencing slowed growth when using steroidal inhalers. Bad for children. Bad for adults. What else to do?

Richard Firshein, DO, director of the Firshein Center for Comprehensive Medicine in New York City, explains his expert's take on steroids and safer, natural alternatives. He acknowledges that inhaled steroids are not a panacea, but they do play a helpful role when symptoms arc particularly troublesome. For example, if a child is experiencing a high level of inflammation and/ or wheezing and missing many school days, Dr. Firshein is apt to prescribe a corticosteroid inhaler for short-term use. However, he does not recommend these drugs on a long-term basis, and emphasized that his first line of defense is to prevent symptoms naturally. Patients with long-term asthma should consider Singulair or a bronchodilator on an "as needed" basis, he says.

BUILD A STRONG FOUNDATION

Asthma has many triggers. Among its possible triggers are airborne pollutants, secondhand smoke, allergens (dust mites, animal dander, mold, chemicals, foods, etc) and cold air.

Also: Aspirin and NSAIDs can trigger an attack, as can aviral infection. To prevent asthma symptoms from occurring in the first place, rather than simply responding to them, Dr. Firshein stresses that you must make healthful changes—changes that reduce the exposure to the things that trigger asthma, and changes that strengthen the body's immune system to resist those triggers. That advice applies not only to children with asthma, but to asthma sufferers of all ages. Allergy shots have also been shown to reduce the sensitivity to allergy triggers such as dust, dust mites, pollen and pet dander.

To build a strong foundation, Dr. Firshein recommends... .

• Closely monitor your environment. Go through your house carefully and remove possible triggers. For example, eliminate dust collectors such as wall-to-wall carpeting and heavy drapes...install an air filter to clean household air...frequently wash non-allergenic bedding and non-allergenic pillow and mattress covers ...use a dehumidifier in damp basements and bathrooms and bedrooms...and avoid using air fresheners. Additionally, do not neglect school or work environments, where we spend so many hours of our lives. It's equally important to eliminate triggers here. Parents should speak directly to principals and teachers about a child's allergy triggers and have the necessary emergency procedures in place, should an attack occur.
• Keep an eye on diet. Dr. Firshein is particularly concerned with asthmatic children eating junk food, which he compares to an adult with heart disease eating fat-laden cheeseburgers and fries. He points out that junk foods promote inflammation, which promotes asthma. Instead, follow an anti-inflammatory diet rich in nutrient- dense whole foods such as fresh fruits and veggies (berries are especially rich in inflammation- fighting antioxidants), fish, nuts and seeds. 'Whenever possible, go with organic products.
• Take immune-boosting supplements. In particular, Dr. Firshein recommends vitamin C (1,000 mg), magnesium (500 mg), fish oil and a good multivitamin. When using inhaled steroids, which may compromise the bones, he also recommends a calcium-magnesium supplement (1,200 mg of calcium) for added protection. Note: Dosages should be reduced in children by 50% to 75% of an adult dosage. In general, he finds that children respond much more rapidly to multivitamins than adults, allowing them to catch fewer colds and miss fewer school/work days, and gain heartier immunity overall with relatively simple supplementation.
• Learn to breathe easy. The Firshein TechniqueforAsthma Breathing is a series of exercises that teach children to stabilize their asthma. He finds that children above age five do particularly well with breathing exercises. Asthma sufferers often feel nervous and out of control when they approach a situation that they know brings on symptorns, such as exercise or cold air. These breathing exercises give individuals a sense of control over a situation, and also strengthen muscles in the diaphragm, which is crucial to controlling asthma.

Dr. Firshein recommends these simple exercises when encountering potential triggers...

• Breathe in through the nose for a count of five, and breathe out through the mouth for a count of seven.
• Next, breathe in deeply, and then blow out the air in a burst like youre blowing out a candle. This strengthens the lungs and diaphragm, explains Dr. Firshein.
• Now use your stomach. Lie down, and as you breathe in through the nose out through the mouth, consciously make your stomach expand.
• Try a rocking motion while standing, breathing in and rocking to one side then breathing out while rocking to the other side. Then switch. Air gets trapped in the lungs of people with asthma, so they cannot take in enough new oxygen, observes Dr. Firshein. Rocking back and forth helps the body use the ribcage more to expel the stale air so there's more room in the lungs.
• Get plenty of exercise. Exercise is doubly important for the asthmatic child, says Dr. Firshein. Breathing exercises work by reducing stress, improving oxygen intake and by strengthening the muscles that are used in respiration. If exercise is a trigger of asthma symptoms, the physician should closely monitor the exercise program. In some cases, breathing exercises may ease and prevent attacks. Using a peak flow meter is the most effective way to monitor breathing at home.

HOW TO INHALE STEROIDS CORRECTLY If you or your child must take steroids for a period of time, Dr. Firshein recommends a safer way to go about using them. Spacing devices provide an effective way of maximizing medication and minimizing deposits in the mouth. He cautions that steroids in dry powder form are difficult to inhale, with often as much as 90o/o of the powdered medication ending up in the mouth. When you swallow this, you are apt to experience greater side effects than with inhalation alone. To reduce side effects, following inhalation, rinse your mouth thoroughly.

A BETTER WAY

With side effects from steroids being so severe and their effectiveness being so limited, they should only be used when they are truly necessary. Using simple strategies that build a strong foundation for your health can lower risk of asthma attacks and cut back on the medication required to control them.