Osteoporosis is a disease in which bones become fragile. With decreased strength, bones have an increased tendency to break or fracture. Since asthma is an inflammatory disease of the lung, continuous use of anti-inflammatory medications is important for most patients with asthma. Cortisone-like medications, called glucocorticosteroids, are the most potent anti-inflammatory medications to treat asthma. There are two types of glucocorticosteroids: oral or systemic, and inhaled or topical. Long-term use of oral glucocorticosteroids, such as the pill prednisone, has been associated with adverse effects, including osteoporosis.
As people age, there is often a significant increase in the number of medications they take for medical problems. It is essential that older patients have an awareness of what medications they are taking, how they to take them and what the potential side effects can be. This is especially true for older adults with allergies or asthma.
There are times when a medication can be very beneficial for one ailment, but has the potential to cause concern for another condition. Such is the case with a particular class of asthma medications: inhaled corticosteroids (ICS). On the one hand, corticosteroids are known to contribute to the development of osteoporosis (a condition leading to brittle bones), which is a common problem for older patients, especially women. On the other hand, ICS are the most effective class of drugs in the treatment of asthma.
Physicians worry that ICS may lead to osteoporosis because oral and injected steroids are well-known to contribute to this process. You may ask, “Why should I take ICS at all for my asthma if it may put me at risk for side-effects?” The reason why ICS are so important for the management of asthma is that this is the most effective class of medication to control asthma.
First, uncontrolled asthma puts you at a high risk for complications requiring hospitalization. Also, if your asthma is uncontrolled, chances are you aren’t sleeping well and exercising is difficult. Reduced levels of activity can also cause osteoporosis. Your physician will weigh the risks of osteoporosis with the risks of asthma, and may prescribe medications to counteract osteoporosis or order bone density testing. Your physician will also suggest things you can do to reduce your risk of osteoporosis. Regular exercise and dietary supplementation with healthcare practitioner prescribed calcium and vitamin D are good ways to reduce the risk.
An allergist/immunologist, often referred to as an allergist, has extensive training in the management of asthma and in minimizing the side-effects of medications such as inhaled corticosteroids.
Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis and urticaria (hives) are common problems for older adults and often require the use of H1 antihistamines. Antihistamines are divided into two classes: first generation antihistamines and second generation antihistamines.
First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common if you are being treated with certain antidepressant medications. The second generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Physician and allergist prescribed antihistamines currently in use are generally from the second or third generation drugs that have an extremely favorable safety profile for users.
Drugs that can Trigger Asthma
These drugs may be used for problems such as high blood pressure, heart disease and migraine headache. They may also be used in an eye drop form for treating the eye disease glaucoma. They are classified in one of two groups: non-specific and specific. Non-specific beta-blockers, such as propanalol, are the most important ones to avoid. Ideally, a person with asthma would avoid all beta blockers, but these types of drugs may be quite important for certain patients’ health and may not substantially worsen their asthma. Your physician may conduct a trial using a “specific” beta-blocker. Remember that even beta-blockers in eye drops may make asthma worse, so be sure to tell your ophthalmologist that you have asthma.
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)
This group of medications include some common over-the-counter pain relievers, such as ibuprofen and naproxen. Approximately 10% to 20% of people with asthma may notice that one or more of these drugs trigger their asthma. These asthma attacks may be severe and even fatal, so patients with known aspirin sensitivity must be very careful to avoid these drugs. Medications that usually don’t cause increased asthma in aspirin-sensitive patients include acetaminophen (low to moderate dose), propoxyphene and prescribed narcotics such as codeine.
These drugs, which may be used for hypertension or heart disease, include lisinopril and enalopril. Although they usually don’t cause asthma, approximately 10% of patients who receive one of these drugs develop a cough. This cough may be confused with asthma in some patients and possibly trigger increased wheezing in others. In addition, any cough can be associated with reflux (acid coming up from the stomach into the esophagus) which can cause more coughing and worsen asthma.
The bottom line in avoiding medication-induced asthma is to talk with your physician about what medications are best for you.
It is important not to let your treatments become asthma triggers.
- Older patients should always know what medications they are taking, how they to take them and what the potential side effects can be.
- Inhaled corticosteroids (ICS) are the most effective class of drugs in the treatment of asthma, but are known to contribute to the development of osteoporosis.
- An allergist has extensive training in the management of asthma and in minimizing the side-effects of medications such as ICS.
- If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine.
- Some drugs, such as beta-blockers and non-steroidal anti-inflammatory drugs (NSAIDs), may trigger asthma in some people.
- To avoid medication-induced asthma, talk with your physician about what medications are best for you.