Your Questions About Corticosteroid Inhaler
August 10th, 2012 by health

John asks…

could my new corticosteroid inhaler be causing my face to blow up?

Hi I was diagnosed with asthma. It got worse so I sought treatment. I was given Flovent. I really liked Flovent. After a week, my symptoms improved and I have been excersizing more. But then I noticed my face getting fat. I already have a very heavy round face for my size. I am perplexed that the doctor would give me a steroid inhaler if he knew my face could blow up, because I told him one of the reasons I need an inhaler is because I am gaining weight through lack of exercise. If my inhaler is causing a fat face, do you think that I could request a different similarly effective inhaler that would reduce my symptoms? What inhaler would be good– I have to request one on the phone because I am no longer insured. It feels a shame, because I like this inhaler. If I continue to use it, will my fat face eventually go away? Could I become permanently disfigured? Thank you.

health answers:

Unfortunately, that’s a common side effect from steriods. They make your body retain water. Just call the nurse at the clinic where you went and tell her what’s going on, and ask if she’ll ask the doc to prescribe a different one. Maybe he can give you one that works as well with less unwanted side effects or or maybe you can just use this one when your asthma symptoms are more severe, instead of routinely. Those symptoms won’t resolve until you decrease or stop taking the steriod but if you stop it the swelling will go down in a few days. You won’t be permanently disfigured.

Daniel asks…

taking a daily corticosteroid but just had mild asthma attack?

Hi, I’m using the Asmanex twisthaler to control my asthma symptoms, but I suddenly had trouble breathing. Is it normal to be on corticosteroids and sometimes still have asthma symptoms? And can I use my albuterol inhaler while I’m on the corticosteroid? Thanks.

health answers:

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Susan asks…

Will taking a flixotide inhaler significantly affect a mantoux test?

I’m having a mantoux test for tuberculosis on Wednesday and I’m a little concerned about taking my flixotide inhaler which contains 250 ug of fluticasone propionate.

The test works by observing an immune response and flitocasone is a corticosteroid which suppresses immune response.

Should I maybe not take it this week? (I’m not going to die of an asthma attack if I skip a few doses). Anyone know if there are rules on this?

health answers:

Call ahead if you can and ask them. They can tell you what you need to do.

Chris asks…

Why should one use a bronchodilator before a corticosteroid?

A Bronchodilator opens up the airway so that the steroid can travel deeper into the lungs to clear the inflammation. Bronchodilators open up and relax constricted airways making it easier to breathe. Steroids are used to reduce inflammation and swelling in the airways. Hence why we use the bronchodilator first, then the steroid inhaler.
-Rekha, RN/BSN

health answers:

Bronchodilators work systemically. They have no local effect. It’s absorbed into the mucosa and thereby the blood vessels. Don’t forget it has to be absorbed through the mucous layer and then the inflamed mucosa before it gets anywhere near the bronchial musculature. And, being Beta 2 agonists they only relax the bronchial muscles. They do not relieve inflammation. The saline is a mucolytic and works faster and locally. Of course, this is when you are taking the unit dose. If you are using the metered dose inhaler (MDI) there is no saline so it’s best to wait 5 minutes for the full effect before taking the steroid. Once you cough the mucous out the bronchodilator can get to the membrane and be absorbed into the circulation faster. It is doing no good being absorbed by the mucous itself.
Albuterol is the chemical evolutionary end product of epinephrine for the relief of bronchospasm. Epinephrine, of course, has primarily beta 1 and beta 2 effects. And it’s very fast acting but it only lasts for maybe an hour. Isuprel was the next step. It’s onset of effect was about 2 minutes but it remained effective for about two hours and the dose, as with epinephrine, had to be titred to the patient’s heart rate. Bronkosol was the next in line. It’s peak effect was achieved in 3-4 minutes but only lasted 3 hours. Alupent was about the same. Albuterol achieves it’s maximum effect in 5 minutes and lasts for about 4 hours. All these meds were created in an attempt to mitigate the cardiac side effects by making them less beta 1 and more beta 2 agonists. Norepinephrine is primarily an alpha agonist and used, in titred doses, for acute laryngotracheobronchitis in children providing a fast acting anti inflammatory.
Now once the bronchodilator is absorbed you can get maximum penetration of the steroid for it’s localized effect on the inflammation and swelling.
Also, a good tip is, if you are ordered to take two puffs from the MDI, wait 5 minutes between puffs so you get maximum effect from the first puff and the second one will get deeper. I know it’s hard to wait but I always told my patients this and they all remarked what a difference it makes.

Carol asks…

how many years can chronic asthmatics depend on cortico steroids?

suppose a person is suffering from chronic asthma
he has been using corticosteroid inhalers from 4-5 years
gradually increasing its dose.
how many more years will the cortico steroids work on him?
can he depend on them life long?

health answers:

You may have to take them for live increasing the dosage and switching around from med to med…

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