Changes in Inhaler Devices for Asthma And COPD

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Posted on: Sunday, 19 June 2005, 03:01 CDT

Changes in Inhaler Devices for Asthma And COPD

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for_asthma_and_copd/

Adverse Effects of Corticosteroid Inhalers

Inhaled corticosteroids may be used in patients with asthma and COPD

being weaned off oral corticosteroids. After withdrawal of oral

corticosteroids, a number of months is required for full recovery of

hypothalalmic-pituitary-adrenal axis function. Patients being weaned

from oral corticosteroids should be assessed for signs of adrenal

insufficiency, or hypotension, fatigue, depression, lassitude,

weakness, joint pain, myalgias, nausea, and vomiting, particularly

during times of stress or postoperatively. Persons who have been on

long-term oral corticosteroids may be immunosuppressed and

susceptible to infections such as chicken pox and measles. Because

corticosteroids can cause immunosuppression, inhaled corticosteroids

should be used with caution in patients with tuberculosis, systemic

fungal infections, bacterial, viral, or parasitic infections, or

ocular herpes simplex. Inhaled corticosteroids also increase risk of

osteoporosis, cataracts, and adrenal suppression in adults ( &

Lipworth, 1997; Patel, 2004; , , Devlin, McFarlane, &

Lipworth, 1998). Due to the wide number of possible adverse effects,

the lowest dosage of inhaled corticosteroids which provide control

for asthma or COPD is recommended (Medical Economics, 2005).

A reduction in growth velocity has been observed in those taking

long-term oral corticosteroids, and has been under investigation in

children and adolescents who use inhaled steroids. Some studies have

found suppression of adrenal function and inhibited growth and bone

development in children who use high doses of inhaled

corticosteroids. Suppression of growth in children on high doses of

inhaled corticosteroids has been detected but appears temporary and

not associated with reduced adult height (Alien, 2004; , ,

& Lipworth, 1996; Goldberg et al., 2002). A recent 3-year study of

inhaled budesonide use in children revealed no effect on adrenal

function (Bacharier et al., 2004). Although there are disparities in

research findings, most investigators agree that the benefits of

inhaled corticosteroids in children outweigh the risks of poorly

controlled asthma. No adequate studies in pregnant or nursing women

are available.

Candida albicans infection of the oropharynx ( " thrush " ) has been

experienced by some long-term users of inhaled corticosteroids.

Rinsing out the mouth after inhaler use may prevent these

infections. Inhaled corticosteroid therapy should be interrupted

temporarily to administer antifungal medications to eliminate

Candida infection (Medical Economics, 2005).

Drug-drug interactions. Flucatisone is metabolized in the liver by

the cytochrome p 450 enzyme system. Ritonavir, a protease inhibitor

used in treatment of HIV infection, is a potent inhibitor of this

hepatic cytochrome system. The concomitant use of ritonavir and

flucatisone resulted in elevated blood levels of flucatisone. This

also occurred with another hepatic cytochrome inhibitor,

ketoconazole. Therefore, ritonavir and ketoconazole should not be

used in conjunction with flucatisone (Medical Economics, 2005).

Adverse effects ofcromofyn. Few adverse effects have been reported

with cromolyn inhalers. Throat irritation, bad taste, bronchospasm,

cough, wheeze, and nausea are rare adverse effects. Cromolyn has not

been evaluated adequately in pregnant or nursing women, or children

younger than age 5 (Medical Economics, 2005; Randolph, 2000).

The Challenge of Patient Education in Inhaler Treatment

For some patients, the coordinated technique needed to obtain the

full dose of medication from a squeeze-and-breathe pMDI is

challenging. Studies show that many patients do not use proper

technique, resulting in inadequate delivery of