No doubt, many kids with persistent asthma will have their lives, education, and sports performance improved by daily inhaled corticosteroids, and these decisions should be always made with a wise and well-read doctor. But with the CAMP trial , the Lancet study, and the BASALT trial suggesting as-needed inhaled steroids may be equivalent to daily use in adults with mild-to-moderate asthma, pediatricians might think twice about continuing a kid with mild asthma -- and a half-decent fastball -- for years on a growth-stunting daily inhaled corticosteroid.
Discuss whether a change in controller medication or decrease in the dose or strength of the inhalant would be an option. Some health experts have reported a reduction in hoarseness after backing down the dose, but this is not always effective. There is a particular inhaled steroid which is inactive until it reaches the surface of the lung (after inhalation). It seems to be an ideal inhalant for people who have adverse effects which are localized to the throat or tongue. The brand name of this unique inhaled steroid is Alvesco. It is only available by prescription. Unfortunately no currently available steroid based inhaler, (including Alvesco) eliminates the risk of dysphonia. One study referenced below suggested reduced risk with some dry powder inhalers.
Hi Ken, enjoyed listening to you do an episode solo!
The tough part I run into with steroid inhalers (at least stateside) is that they’re very costly! Patients tend to use their beta-agonist inhalers (. albuterol for us) a lot more as a replacement/rescue therapy, because the refills are comparatively cheap. When you look at the issue from a cost-efficiency perspective, do you think the argument for adding inhaled steroids on top of systemic steroids (which aren’t all that expensive out-of-pocket), is still compelling for patients who may not have insurance?