"The effect of inhaled steroid use on bone density was shown to be dose related," notes Lenfant. "We encourage all patients with asthma to work with their doctors on a comprehensive treatment plan; that is, the lowest possible dose of inhaled steroids that controls their asthma symptoms as well as measures to maintain good bone health, such as adequate calcium and vitamin D intake."
One option to lower steroid dosage is to supplement therapy with long-acting beta-agonists. Two studies by the NHLBI Asthma Clinical Research Network recently found that adult men and women with mild-to-moderate persistent asthma who used both medications were able to reduce steroid dosage, on average, by 50 percent without losing symptom control.
Those treated with long-acting beta-agonists alone, however, suffered from significantly worse symptoms compared to those treated with inhaled steroids alone or with both medications. These findings were reported in the May 23, 2001, issue of the Journal of the American Medical Association.
Another recent study, NHLBI's Childhood Asthma Management Program, found that inhaled steroids offered superior control with no long-term effect on bone density, as reported in the October 12, 2000, NEJM.
In this five-year study of children ages 5 to 12 years, investigators found a small but temporary reduction in the rate of growth of those treated with inhaled steroids.
In general, results of earlier studies on the effect of inhaled steroids on bone density have been conflicting, although long-term use of oral steroids has conclusively been associated with accelerated bone loss and increased rate of fractures.
The September 27, 2001, NEJM research report foun
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NIH/National Heart, Lung, and Blood Institute
26-Sep-2001