[Study] Use of steroid inhalers increases risk of NTM in some patients

Posted by sweethighland @sweethighland, Aug 15 3:03pm

Treating asthma or COPD with steroid inhaler raises the risk of hard-to-treat infections
https://erj.ersjournals.com/press/2109-treating-asthma-or-copd-with-steroid-inhaler

Interested in more discussions like this? Go to the MAC & Bronchiectasis group.

Ouch! I read this title and immediately got worried. Then I read the summary in the link, and didn't feel like it was very helpful.
It sounded like good science, reporting on a study of over 400,000 patients with asthma or COPD, but then it reported about 3000 infections among them. Is that a lot or a little for that population? What steroid? Who was at risk? So, I sat down and read the whole report (it is filled with footnotes and statistics – torturous reading, for me at least!) Find it here:
https://erj.ersjournals.com/content/50/3/1700037
Now, what does the full report say?
This study addressed ONLY the use of inhaled corticosteroids, not the other drugs commonly prescribed.
People with Asthma or COPD may get NTM/MAC with or without using inhaled corticosteroids (ICS.)
The highest risk is use of the ICS fluticasone by people with COPD or Asthma + COPD.
The higher the dose, the greater the risk of infection.
The increased risk of using fluticasone in Asthma only patients is not statistically significant.
Other ICS inhalers, including the next most commonly used, budosenide, did not demonstrably increase the risk of infection in any group. In fact, the number of infections among budosenide & other ICS users was less than the number in the population that did not use any ICS.
About 1/3 of patients who got NTM had also used oral steroids within one year of infection; 2/3 also used one or more asthma/COPD control medications. There was no analysis of whether these led to increased risk.
NTM/MAC risk is significantly lower for Asthma and COPD patients than risk of pneumonia. It is thought that ICS reduce pneumonia risks.
The report concludes that risks of fluticasone should be considered at part of the overall treatment plan,

What is the takeaway?
Each patient, with their medical provider, needs to evaluate both the risks associated with medication and the quality of life gained by using it.
The provider should recommend the safest available medication in the lowest possible dose.

Here is my story:
I have asthma, reactive airways and bronchiectasis. I have had MAC. I was reluctant to use my steroid inhaler because I was afraid the MAC would come back. I am using a rescue inhaler many times a day, and I walked around feeling like there was "an elephant on my chest."

My pulmonologist insisted she could improve my quality of life. With Symbicort (budosenide plus formoterol), that heavy feeling is almost absent, the rescue inhaler stays in my pocket, and I have the energy to get through my day.

I hope this helps you make sense of the complexity of life with MAC
Sue

REPLY
@sueinmn

Ouch! I read this title and immediately got worried. Then I read the summary in the link, and didn't feel like it was very helpful.
It sounded like good science, reporting on a study of over 400,000 patients with asthma or COPD, but then it reported about 3000 infections among them. Is that a lot or a little for that population? What steroid? Who was at risk? So, I sat down and read the whole report (it is filled with footnotes and statistics – torturous reading, for me at least!) Find it here:
https://erj.ersjournals.com/content/50/3/1700037
Now, what does the full report say?
This study addressed ONLY the use of inhaled corticosteroids, not the other drugs commonly prescribed.
People with Asthma or COPD may get NTM/MAC with or without using inhaled corticosteroids (ICS.)
The highest risk is use of the ICS fluticasone by people with COPD or Asthma + COPD.
The higher the dose, the greater the risk of infection.
The increased risk of using fluticasone in Asthma only patients is not statistically significant.
Other ICS inhalers, including the next most commonly used, budosenide, did not demonstrably increase the risk of infection in any group. In fact, the number of infections among budosenide & other ICS users was less than the number in the population that did not use any ICS.
About 1/3 of patients who got NTM had also used oral steroids within one year of infection; 2/3 also used one or more asthma/COPD control medications. There was no analysis of whether these led to increased risk.
NTM/MAC risk is significantly lower for Asthma and COPD patients than risk of pneumonia. It is thought that ICS reduce pneumonia risks.
The report concludes that risks of fluticasone should be considered at part of the overall treatment plan,

What is the takeaway?
Each patient, with their medical provider, needs to evaluate both the risks associated with medication and the quality of life gained by using it.
The provider should recommend the safest available medication in the lowest possible dose.

Here is my story:
I have asthma, reactive airways and bronchiectasis. I have had MAC. I was reluctant to use my steroid inhaler because I was afraid the MAC would come back. I am using a rescue inhaler many times a day, and I walked around feeling like there was "an elephant on my chest."

My pulmonologist insisted she could improve my quality of life. With Symbicort (budosenide plus formoterol), that heavy feeling is almost absent, the rescue inhaler stays in my pocket, and I have the energy to get through my day.

I hope this helps you make sense of the complexity of life with MAC
Sue

Jump to this post

Thank you Sue. I recently started Albuterol inhaler but it gives me shaky hands and fast heart rates (130 today). Maybe I should not use it. I am concerned what if inhaler gives me an infection. I don't have asthma but my doctor gave me Albuterol in case I have tight chest. I tend to have tightness in the chest when I wake up, maybe from mucus build up during the night. That was why I tested inhaler to see if it helps. I dare not use it again after today.

I am watching this right now:

Update on Bronchiectasis Treatments Including new Investigational Therapies
http://www.youtube.com/watch?v=b7-SYvCEFME

REPLY
@sweethighland

Thank you Sue. I recently started Albuterol inhaler but it gives me shaky hands and fast heart rates (130 today). Maybe I should not use it. I am concerned what if inhaler gives me an infection. I don't have asthma but my doctor gave me Albuterol in case I have tight chest. I tend to have tightness in the chest when I wake up, maybe from mucus build up during the night. That was why I tested inhaler to see if it helps. I dare not use it again after today.

I am watching this right now:

Update on Bronchiectasis Treatments Including new Investigational Therapies
http://www.youtube.com/watch?v=b7-SYvCEFME

Jump to this post

Please! Don't let the very small chance (1/10th of 1%) that you might develop MAC stop you from using a helpful medication. Especially, given that you already have an infection that I assume is being treated, the antibiotics will keep a new one from settling in.

As for the albuterol, yes, it is great at making me feel shaky. Instead I use levalbuterol, which does not have the same effect. By the way, albuterol & levalbuterol are not steroids.

Also, if you are nebulizing saline, it is helpful to use a puff of albuterol or levalbuterol first to open the airways.

Remember, with every health and medication decision there are tradeoffs. Being able to breathe deeply and comfortably usually means you will feel better, be more active, be more able to exercise, and thus generally be more healthy.
Sue

REPLY
@sweethighland

Thank you Sue. I recently started Albuterol inhaler but it gives me shaky hands and fast heart rates (130 today). Maybe I should not use it. I am concerned what if inhaler gives me an infection. I don't have asthma but my doctor gave me Albuterol in case I have tight chest. I tend to have tightness in the chest when I wake up, maybe from mucus build up during the night. That was why I tested inhaler to see if it helps. I dare not use it again after today.

I am watching this right now:

Update on Bronchiectasis Treatments Including new Investigational Therapies
http://www.youtube.com/watch?v=b7-SYvCEFME

Jump to this post

@sweethighland I agree with Sue @sueinmn that any drug you take has it's side effects, but you must weigh that against the positive effects it may have. Quality of Life is very important to all of us. It appears to me the inhaled steroid has a low risk of causing NTM infections. Maybe you could take a lower dose or less often and still be effective with a lower risk of side effects. You might ask your health providers their opinion. Bill

REPLY
@sueinmn

Please! Don't let the very small chance (1/10th of 1%) that you might develop MAC stop you from using a helpful medication. Especially, given that you already have an infection that I assume is being treated, the antibiotics will keep a new one from settling in.

As for the albuterol, yes, it is great at making me feel shaky. Instead I use levalbuterol, which does not have the same effect. By the way, albuterol & levalbuterol are not steroids.

Also, if you are nebulizing saline, it is helpful to use a puff of albuterol or levalbuterol first to open the airways.

Remember, with every health and medication decision there are tradeoffs. Being able to breathe deeply and comfortably usually means you will feel better, be more active, be more able to exercise, and thus generally be more healthy.
Sue

Jump to this post

I use a nebulizer with Brovana twice daily but follow it up with a puff of Alvesco 160mcg. I noticed that you stated that if one is nebulizing saline it is helpful to use a puff of albuterol or levalbuterol prior to nebulizing. I only need the levalbuterol rescue inhaler perhaps one or two times per year, and use it at the docs office when doing the PFT. Have been on this protocol for almost 7 years and have an Allergy/Asthma Specialist for a pulmonary doc.

REPLY
@baz10

I use a nebulizer with Brovana twice daily but follow it up with a puff of Alvesco 160mcg. I noticed that you stated that if one is nebulizing saline it is helpful to use a puff of albuterol or levalbuterol prior to nebulizing. I only need the levalbuterol rescue inhaler perhaps one or two times per year, and use it at the docs office when doing the PFT. Have been on this protocol for almost 7 years and have an Allergy/Asthma Specialist for a pulmonary doc.

Jump to this post

Using the Brovana neb, followed by the saline neb, would have the same effect. Brovana is a form of formoterol, which is a bronchodilator similar to albuterol. No need to add yet another med!
Have you begun nebulizing 7% saline?
Sue

REPLY
@poodledoc

@sweethighland I agree with Sue @sueinmn that any drug you take has it's side effects, but you must weigh that against the positive effects it may have. Quality of Life is very important to all of us. It appears to me the inhaled steroid has a low risk of causing NTM infections. Maybe you could take a lower dose or less often and still be effective with a lower risk of side effects. You might ask your health providers their opinion. Bill

Jump to this post

Thank you Bill. Will do lower dose if I need to use it again. As with Saline HP+ from Sams club, do I need prescription?

REPLY
@sweethighland

Thank you Bill. Will do lower dose if I need to use it again. As with Saline HP+ from Sams club, do I need prescription?

Jump to this post

@sweethighland Yes you will need a prescription for the 7% saline. But then you can ask your pharmacy to order you a specific brand name. I much prefer the Pulmosal 7% pH+ brand because it is pH balanced and let irritating for me.

REPLY
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