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Can Symbicort and Arnuity Ellipta be used for a long duration?

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Posted on Tue, 21 Mar 2017
Question: Question on steroidal inhalers: I have some steroidal inhalers (Symbicort 160/4.5 and also Arnuity Ellipta 100 mcg) prescribed for pulmonary inflammation from mycotoxicosis - mold poisoning - which my doctor thinks may be presenting as granulomatosis with polyangiitis based on positive autoantibodies to myeloperoxidase and proteinase-3. I also have severe asthma. The usage manuals state the steroidal inhalers increase risk of death from asthma problems in asthmatics, and can cause dangerous immunosuppression in patients with underlying infection (such as myself). The prescribing doctor is alleging the budesonide in Symbicort prevents increased risk of death in asthmatics (though usage manual states it is unknown whether budesonide accomplishes this or not), and that immunosuppression is localized in mouth and lungs only (though, again, usage manual states otherwise). Are there immunologists or pulmonologists on here who can speak to the risks of increased death from asthma and immunosuppression in the case of asthmatics with underlying chronic infections?
doctor
Answered by Dr. Shashi Dangwal (3 hours later)
Brief Answer:
The beneficial effects outweigh the side effects in case of inhalers.

Detailed Answer:
Hello XXXX,

Thanks for posting your query on HealthcareMagic.

For the treatment of asthma, inhalers are used which are the mainstay of treatment of asthma. These inhalers used by you contain long acting beta agonist (LABA)and steroids. Yes, there are few side effects to these like increased incidence of cardiac events due to LABA but these are rare. Similarly there may be immunosuppresion with steroids but incidence greatly reduces with inhaled steroids and seen after prolonged use.

Almost all medicines have some side effects but that does not mean that every person who takes it will develop these. Over and above one has to weigh the pros and cons. The beneficial effects outweigh these side effects in case of these inhalers. Other medicines for asthma are not as effective as inhalers and severe asthma itself can lead to increased morbidity and mortality including death. Hence you should take these inhalers but be under regular supervision of your PCP or a pulmonologist.

Hope this answers your query.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Shashi Dangwal (2 days later)
My grateful thanks for your response Dr. Dangwai! That is helpful information for me.

Follow up questions:

I. If I was able to normally manage my asthma using rescue inhalers like albuterol sulfate, could the steroidal inhalers I have - or steroidal inhalers in general - be used on a PRN/as-needed basis during exceptional times when the rescue inhaler did not work effectively enough?

II. Are there non-steroidal medications that could be used to treat pulmonary inflammation effectively in patients who have underlying chronic infectious disease as the source of the inflammation?
doctor
Answered by Dr. Shashi Dangwal (2 hours later)
Brief Answer:
Yes you can continue rescue inhalers .

Detailed Answer:
Yes, if with rescue inhalers your symptoms are under control you may continue to use them and not use steroid inhalers. Steroid inhalers are used in chronic persistent asthma where control of inflammation is needed.

Other medicines which can be used for control of inflammation and symptoms are monteleukast lc, theophyllines and antimuscarinic inhalers like ipratropium and tiatropium. They can be used individually or to gether as the need be. You will have to consult your PCP or a pulmonologist who can guide you on their use and dosage and for a prescription.

Take care.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Shashi Dangwal (8 hours later)
Thank you kindly Dr. Dangwai.

As regards my first follow up question, if albuterol sulfate is usually sufficient to control asthma symptoms but insufficient at controlling asthma symptoms every once in a while, is it ok to take long-acting inhalers - be it steroidal or non-steroidal ones such as you mention (ipratropium and tiatropium) - on a PRN/as-needed basis on top of the albuterol?
doctor
Answered by Dr. Shashi Dangwal (8 hours later)
Brief Answer:
Yes you may add another inhaler or one of the tablets mentioned above

Detailed Answer:
Yes you may add another inhaler or one of the tablets mentioned above to albuterol for better control of symptoms but steroid inhalers and monteleukast lc will have to be taken for atleast week to ten days for their full effects to be manifested.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Shashi Dangwal (2 days later)
Thank you kindly Dr. Dangwai.

So if steroidal or non-steroidal inhalers to manage inflammation need to be taken regularly to build up in the body, than they thus cannot be taken on and off on PRN bases like rescue inhalers, is that correct?
doctor
Answered by Dr. Shashi Dangwal (1 hour later)
Brief Answer:
Only steroid inhalers and monteleukast.

Detailed Answer:
Only steroid inhalers and monteleukast because they act by controlling inflammation and are called controllers. They need sometsometime for their action to be manifested.

Other inhalers like tiatropium and deriphylline act like rescue inhalers and can be taken prn.
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Shashi Dangwal

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Can Symbicort and Arnuity Ellipta be used for a long duration?

Brief Answer: The beneficial effects outweigh the side effects in case of inhalers. Detailed Answer: Hello XXXX, Thanks for posting your query on HealthcareMagic. For the treatment of asthma, inhalers are used which are the mainstay of treatment of asthma. These inhalers used by you contain long acting beta agonist (LABA)and steroids. Yes, there are few side effects to these like increased incidence of cardiac events due to LABA but these are rare. Similarly there may be immunosuppresion with steroids but incidence greatly reduces with inhaled steroids and seen after prolonged use. Almost all medicines have some side effects but that does not mean that every person who takes it will develop these. Over and above one has to weigh the pros and cons. The beneficial effects outweigh these side effects in case of these inhalers. Other medicines for asthma are not as effective as inhalers and severe asthma itself can lead to increased morbidity and mortality including death. Hence you should take these inhalers but be under regular supervision of your PCP or a pulmonologist. Hope this answers your query.