Posted by Brigham and Women's Hospital May 9, 2013
Today’s post was written by Dr. Christopher Fanta, a pulmonologist, and Dr. David Sloane, an allergist, both physicians at Brigham and Women’s Hospital and at Partners Healthcare Asthma Center. The post originally appeared on the Partners Asthma Center’s Asthma Blog.
Asthma is a disease of the lungs, not the bones. So what’s the connection? The most important connection relates to the anti-inflammatory steroids (corticosteroids) used to treat asthma. Corticosteroids, if taken regularly or for many months of the year, can have major effects on the bones. This is especially true of steroids taken orally. In children, they can impair bone growth, leading to lesser height as an adult. In adults, steroids can decrease bone mass and predispose them to osteoporosis, a thinning of the bones. Osteoporosis can put you at risk for fractures, sometimes with minimal or no trauma. It can cause vertebrae in your back to collapse in on themselves (vertebral compression fractures), ribs to break with coughing or twisting, and hips to break when you fall.
Because of the impact on bones and other side effects of oral corticosteroids, safer alternatives to treat asthma were developed. Inhaled corticosteroids are now available in many forms (metered-dose inhalers, dry-powder inhalers, or a solution for nebulization). Inhaled steroids are far safer for your bones because they are given at a fraction of the dose of oral steroids, with only a small portion entering the bloodstream. However, if the dose of inhaled steroid is high enough and the duration of use long enough (several years), it is possible that inhaled steroids, like oral steroids, can still affect your bone health.
The potential risk to your bones does not mean that you should stop using your steroid inhaler. Many people must take daily inhaled steroids for control of asthma. In most instances, inhaled steroids prevent or reduce the need for oral steroid tablets, which have a far greater impact on your bones.
Instead, it means that you and your health care provider should work together to maintain good bone health. Regular weight-bearing physical activity is a good way to strengthen your bones. Adequate intake of calcium and vitamin D, either in our diets or as dietary supplements, is also important “fuel” for our bones. Your doctor may prescribe a medication that can slow the development of osteoporosis and even reverse it.
Finally, your health care provider can help you assess your risk for low bone mass. He or she may recommend measurement of your bone density with an X-ray specifically designed for this purpose, called bone densitometry. People at risk for osteoporosis (especially – but not only – thin women following menopause) are typically screened with bone density X-rays approximately every two years.
Remember: good breathing and good bone health are both possible. Your doctor can help you develop a plan to achieve both.
More resources for people with asthma: