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EVIDENCE THAT INHALED STEROIDS REDUCE HOSPITAL ADMISSIONS AND DEATHS

1). “Regular users of inhaled corticosteroids were either 40%”(during the first year) “or 80%” (during subsequent years), “less likely than regular users of theophylline to be admitted to hospital for asthma”.[1] 2). “Irregular users did not benefit from a reduction in the risk of hospital admission for asthma”.[1] 3). “The rate of deaths from asthma among users of inhaled corticosteroids decreased by 21% for every additional canister of inhaled corticosteroids used during the previous year”.[2] 4). “The rate of deaths from asthma during the first 3 months after discontinuation of inhaled corticosteroids was (4.6 times) higher than the rate among patients who continued to use the drug.”[2] Lingering suspicions of serious adverse effects from long-term use of inhaled corticosteroids in low dosage (50 mcg per puff), should be removed by the two studies quoted above. Complex calculations came up with these conclusions, and the second paper finally addressed the contentious question of whether low-dose inhaled corticosteroids can prevent deaths from asthma—yes, they can, if taken regularly; only one of the patients who died used six or more 200-puff canisters (the Canadian word for inhalers), during the preceding year. The exact mechanism of this protection remains unknown, but besides reduction in the number of acute exacerbations, inhaled steroids have been shown to reduce the maximal airway narrowing to inhaled methacholine, and presumably also to inhaled allergens.[3] Some wonderful record-keeping in Saskatchewan, Canada, (their Health Data Bases), enabled researchers to follow the progress of all the subjects using anti-asthma drugs amongst a population of over 30,000 people, during 1975-1991. Seventy seven out of the total 562 deaths were due to asthma. Examination of medical records showed that 53% of asthmatics who died, and 46% of ‘control’ asthmatics, had used inhaled steroids in the previous year. An article in the September issue of Thorax reviews the Saskatchewan study, and all the other evidence for any effect of low-dose inhaled steroids either increasing or decreasing the likelihood of death from asthma.[4] The conclusion is that they really do decrease the likelihood in the long-term. If you are still unconvinced, be assured that Prof Richard Beasley of Wellington, in a brilliant exposition just before the Foundation AGM in October, was at pains to emphasise this same information. (I trust you were shocked to learn that less than half of the asthmatics in Saskatchewan were taking any inhaled steroids at all! One discovers also that theophylline was the main basic asthma treatment there during those years). 1 Thorax 1998;53:1025-9 2 New Eng Med J;343:332-6 2000; 3 Am Rev Resp Dis 1991;145:109-13 4 Thorax 2001;56 (Suppl ii):ii 74-ii78

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