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Is Inhaled Corticosteroid The Right Treatment For Asthma?

Posted on Tue, 9 May 2017

Question: As a person with asthma since 2 yrs of age (now 78) I read a lot of descriptions for meds. My doc has suggested I try Breo in a.m. and Stiolto Resprimat in evening as a trial. After reading most of the literature, I'm concerned that other docs may suggest other meds that might conflict. I have been on Advair 250/50 for several years but this spring (allergies and the pollen) things have been rough. What exactly is an inhaled cortisoic steroid (sorry about spelling) Also on one instruction list I read a warning about using prednisone at same time as Breo.

Answered by Dr. Drkaushal85 (3 hours later)

Brief Answer:
You are already taking inhaled corticosteroid.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
I have gone through the reports you have attached.
Inhaled corticosteroid (ICS) is the mainstay treatment for asthma.
And you are already taking ICS. Advair and breo, both have fluticasone and fluticasone is ICS.
Prednisone is oral corticosteroid.
Oral corticosteroids are having a lot of side effects on long term use. While ICS are very safe and having least side effects because they act directly on lungs without going to systemic circulation.
And this is the reason why ICS are used as long term treatment for asthma control.
It is better not to take oral corticosteroid (prednisone).
But if you are prescribed to take, you can take it after breakfast.
You can take your breo inhaler anytime as well there is no drug interactions with breo and prednisone.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Drkaushal85 (9 hours later)

Thank you for your explanation of corticosteroids. I would also note that the "theophylline" I am on is Theo-24 (400mg a.m. and p.m). At this present time, my inhaler routine is to take one inhale of Proventil mid a.m. followed by one inhale of Advair 250/50 (30-60) minutes later, and to follow the same routine beginning 9-9:30 p.m.Would you suggest that one might conduct a trial test taking Advair 500/50 for say 30 days vs jumping into a Breo inhaler in a.m. and Stiolto Resprimat inhaler in p.m. routine. I have tested Advair 500/50 a couple of times for 7 days each over the past 6 months with no apparent improvement in lung function vs 250/50. Appreciate your time and value the input. Tom Gravins

Answered by Dr. Drkaushal85 (15 hours later)

Brief Answer:
Better to start breo and stiolto inhalers.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Sorry for late reply as I was busy.
In my opinion, you should try breo and stiolto inhalers instead of increasing dose of advair.
Breo an stiolto gives you complete bronchodilators and ICS as both combined carries (fluticasone - ICS, tiotropium - antimuscarinic and odolaterol - beta agonist).
So breo and stiolto should be tried instead of higher dose advair.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Drkaushal85 (15 hours later)

Moving to a Breo and Stiolto routine should eliminate need of using inhale of Proventil as part of my current regimen to sped up effectiveness of Advair 250/50 inhale? But Proventil is still OK to use along with Breo and Stiolto if a sudden close down of lungs develops? Once again thanks for your time and opinions. Tom Gravins

Answered by Dr. Drkaushal85 (8 hours later)

Brief Answer:
Yes, you can take proventil inhaler in between.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Proventil is having albuterol. It is short acting beta 2 agonist (SABA). It is rescue inhaler. It can be taken on SOS (as and when required) basis.
So start breo and stiolto inhalers. If you need proventil in between, you can definitely take proventil.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (15 hours later)

Dr. Bhavsar, unfortunately I have misplaced your comments reference use of Mtheyl-Prednisone PAKs (4mg-5mg) 21 pills over 6 day. I have a tendency for bouts with gout in my feet and the most effective treatment has been these prednisone paks. I've even had my pulmonary doc "double" down this time last year when I was full of congestion. Obviously I was not on Breo or Stiolto. Your comments are appreciated and helpful when in discussion with other docs. Thanks

Answered by Dr. Drkaushal85 (9 hours later)

Brief Answer:
I can't understand what you are trying to say.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Sorry to say but I can't understand what you are trying to say.
What is this gout and methylprednisolone thing?
Sorry for this but I don't know what to reply on your this follow up query.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (33 hours later)

The gout is a kind of arthritis that can come on suddenly with burning pain usually in the foot and can be very disabling. Methyl Prednisone treats arthritis, blood disorders, allergic reactions and lungs diseases according WebMD. I was about to start my trial with Breo and Stiolto when I had a gout attack and began a 6 day prednisone pack (6-5-4-3-2-1) of 21 pills. Literature on Breo, as I understood it, cautioned against combining the two. Tom Gravins

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Yes, you can take both together.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you can take both (prednisone and breo, stiolto) together. No harm in it.
And I know what is gout. But prednisone is not a first line drug for gout. Prednisone is usually given when painkillers (NSAIDS) are not working.
Have you tried NSAIDS for gout?
Oral prednisone should be started straight for gout.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T