Dr James Guevara, Department of Pediatrics at the University Of Pennsylvania School Of Medicine in Philadelphia and lead review author of this study, said that corticosteroids are better when administered in moderate low doses when compared to low doses.

From News.Bio-Medicine.org:

Inhaled corticosteroids (ICS) and sodium cromoglycate (SCG) are both used to help people with asthma. SCG is believed to have a low risk of causing long-term side effects, but despite anxieties relating to routine use of steroids, the use of ICS has steadily increased since the 1990s.

While they are both known to work, there has previously been a debate as to whether one is superior to the other.

By pooling data from randomized controlled trials that directly compared the effects of ICS and SCG the Cochrane Review Authors could assess the relative benefits of each. They considered measures of lung function, asthma control and the use of general healthcare services such as GPs and hospitals.

Their conclusion was that ICS controls asthma better than SCG and that it also leads to improved lung function. They were, however, unable to decide whether there were differences in side-effects as most of the trials ran for too short a time to assess long-term outcomes.

“The superiority of ICS over SCG appears to increase when patients use moderate doses of ICS, compared with when low doses of ICS are used,” says lead Review Author Dr James Guevara, who works in the department of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

It was concluded by Dr Guevara that steroids are effective options for people fighting against asthma.

It was remarked by James Guevara, M.D., of the University of Pennsylvania School of Medicine and colleagues, that asthmatic patients on steroids tend to experience average three fewer severe asthma flare-ups each year, scored better on lung function tests, and make lesser use of inhalers than their counterparts on cromolyn.

From News-Medical.Net:

“Any expert would agree that inhaled corticosteroids are preferred first-line therapy for treatment of persistent asthma, which requires daily therapy. But we also will agree with the NIH [National Institutes of Health] asthma guidelines, which state that cromolyn and other drugs are alternative therapies,” Storms said.

Cromolyn, or sodium cromoglycate, and inhaled corticosteroids both block the action of certain inflammatory cells in the lungs. Physicians recommend both types of medication for persistent asthma, but individual studies disagree about which type of medication works best, the reviewers found.

“The safety of sodium cromoglycate has been well established, but the effectiveness of sodium cromoglycate in controlling asthma symptoms may be limited,” Guevara said, adding that the lack of effective control might be one reason cromolyn has fallen out of favor compared to inhaled corticosteroids since the 1990s.

William Storms, M.D., an allergist at the University of Colorado Health Sciences Center and director of the William Storms Allergy Clinic in Colorado Springs, remarked that this consensus does not mean that there is no room for cromolyn treatment.

This call for caution was made after it was found that some of the presently used anti-inflammatory medications increase the risk of pneumonia by a full third.

Almost 11 million Americans on a yearly basis are suffering from COPD and most of them belong to the category of present or former smokers.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

Lead author of this study, pulmonologist M. Brad Drummond, M.D., M.H.S., was of the view that this finding will serve as a reminder to the doctors and patients with severe lung disease to plan and take steps for reducing the risk of pneumonia that doubles the risk of death.

The involved researchers were studying the effectiveness of both a low-dose corticosteroid (budesonide) and beta2-agonist (formoterol) in a single inhaler.

The review appeared in an issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization evaluating research in all health care aspects.

From News-Medical.Net:

“Encouraging people to use their preventive medication is important, as it is often the case that people with asthma default on their inhaled corticosteroids,” said lead reviewer Christopher Cates, M.D., at the Community Health Sciences of St. George’s at the University of London. “This is partly because inhaled steroids do not make an immediate difference to asthma symptoms.”

In most studies, participants had treatment with a single inhaler – one inhalation of 80/4.5 milligrams of budesonide/formoterol twice daily, and as needed. Patients in the control groups used their prescribed inhaled corticosteroid with a separate reliever inhaler. Cates and his colleague evaluated three studies that included more than 4,200 adults and adolescents with chronic asthma. One study also included 224 children.

The Cochrane reviewers found no significant reduction in the number of asthma exacerbations that required hospitalization among the patients who used single inhaler therapy.

It was remarked by Cates that one benefit of combined inhalers is that inhaled corticosteroids can be administered on an automatic basis with the beta-agonist when it comes to relieving symptoms.

The survival rate of these patients gets improved by a considerable extent, according to Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of this study.

From Bio-medicine.org:

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Dr. Macie was quick to remark that COPD patients administered with corticosteroids showed far better improvements than those not making a use of them. It was also remarked that COPD patients (on corticosteroids paired with beta- agonists) experienced a 25 percent reduced all-cause mortality rate and 38 percent reduced death rate within 30 days of hospital discharge.

Important side effects have emerged along with the benefits of high dose corticosteroids, according to Rebecca Green, M.D., Ph.D., assistant professor, pediatric endocrinology and diabetes, Washington University School of Medicine in St. Louis, Mo.

From News-Medical.Net:

Inhaled corticosteroids are one of the most effective medications for controlling asthma. These anti-inflammatory medications reduce swelling in the airways, improve lung function and act to prevent asthma episodes or “asthma attacks.” Intervention with inhaled corticosteroids can improve asthma control and reduce emergency department visits, hospitalization and deaths.

The side effects attributed to corticosteroids include decreased bone mineral density and reduced bone mass, and also in children, reduced growth rate. According to Dr. Green, strategies to alleviate these effects include minimizing oral doses and adding topical or inhaled steroids to provide the same anti-inflammatory benefit in the areas affected by inflammation while avoiding systemic effects. Disturbance in bone acquisition in childhood can reduce peak bone mass and therefore significantly impact the life time risk of osteoporosis.

“One of the challenges has been distinguishing the effects of the inflammatory process itself on bone mass and growth, and the effects of corticosteroids on bone growth from the effects of corticosteroids on bone mass,” she said.

It was remarked by Dr. Kelly, professor emeritus of pediatrics, University of New Mexico Health Sciences Center, Albuquerque, N.M., that a possible risk associated with inhaled corticosteroids‘ use can be outweighed by the ability to reduce the amount of oral corticosteroids used in children.

It was proved during the study that higher doses of steroids are as effective as the combination therapy in itself for preventing asthma attacks, according to a second review.

From News-Medical.Net:

Asthma patients who used both LABA medication and an inhaled steroid were significantly less likely to have a severe asthma flare-up requiring treatment with an injected or swallowed steroid than patients taking the steroid alone, according to Muireann Ni Chroinin, M.D., of the Norfolk and Norwich University Hospital in England, and colleagues.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The rate of severe attacks dropped from 27 percent to 22 percent in patients taking the combination therapy. Ni Chroinin and colleagues calculate that 18 patients would need to be treated with LABA for one year to prevent at least one patient from having such an attack.

Jerry Krishnan, M.D., an asthma researcher and assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine, remarked that he believes that there is a propensity for initiating combination therapy with LABAs (long acting beta-2 agonists) and inhaled corticosteroids.