Dear doctor,

My 5-year-old daughter has asthma. What is the effect of using an asthma preventer long-term? I heard that using it for years might cause bone shrinkage. Is it true?

Lily

Dear Lily,

It is worrisome if a child or even adult has asthma. Recurrent attacks of cough and breathlessness worry the sufferer as well as family members. Asthma is a condition, where due to exposure to certain allergy producing substances, the airways (tubes involved into and from passage of air from lungs) get inflamed and narrowed. Following the inflammation, secretions are produced from airways which one cannot bring out due to their narrowing. This produces respiratory distress and cough. Some people are susceptible to asthma but in majority of cases it is inherited. There will be a blood relative (either close or distant) who is/was suffering from asthma or similar allergy related problems like eczema or recurrent cold.

Since it is inherent, there is no definite cure. Anti inflammatory, and bronchodilator drugs (which open up blocked tubes) are used preferably by inhalation to prevent and abort the attacks. Corticoids are used as preventers as well as for treatment in inhaled form for asthma.  Since some amount of inhaled drug is also absorbed systemically, long term use can produce side effects of corticoids like softening of bones, masculinization in case of girls, obesity, etc. But if taken correctly, this risk is miniscule.  Locally it can produce fungal infections in the mouth sore throat and or hoarse voice. The risks can be minimized by using a spacehaler, i.e. where a small chamber exists between the mouth and the device. Spitting out and rinsing the mouth after each puff also minimizes risk of systemic absorption and side effects. Some drugs are available in form of ultra refined particles which have minimum risk of systemic infection.

If one does not have very severe attacks, he can use non corticoid inhalers, which prevent side effects of corticoids. In case of asthma attacks occuring at predictable times, one can use inhalers containing sodium chromoglycate which prevents the attack, thus avoiding side effects of corticoids.

It is also advisable to prevent exposure to potential allergens like dust.