By Melissa Schorr

Is your asthma inhaler buried at the bottom of your medicine cabinet?
　　That could put you at jeopardy, say Canadian researchers, who are reporting today in the New England Journal of Medicine that using an asthma inhaler could reduce your chances of dying of an asthma attack.
　　But despite these important findings, asthma experts say many doctors and patients are still reluctant to use inhalers faithfully.
　　Over 17 million Americans, including nearly 5 million children, suffer from asthma, a chronic inflammation of the airways that causes wheezing, coughing, breathlessness;and 14 deaths a day in the U.S.
　　The number of asthma cases has doubled since 1980, leading the Department of Health and Human Services to declare asthma “an epidemic?in its Action Against Asthma report issued this May.
　　Despite strong recommendations from the National Heart, Lung and Blood Institute for use of these long-term medications to prevent attacks, many patients are reluctant to use asthma inhalers containing high doses of corticosteroids because they have been linked to stunting growth in children, and causing cataracts, glaucoma and osteoporosis in adults.
　　Steroid-Phobia?
　　“There’s steroid-phobia here in the U.S. amongst primary care physicians and pediatricians,"?says Dr. H. William Kelly, professor of pediatrics at the University of New Mexico, who served on the NIH’s expert panel on asthma. “Despite our best efforts, there’s a significant lack of use of cortiosteroids, compared to other countries. We don’t use them nearly enough."?br /> 　　There is a persistent misconception that inhaled steroids cause the same negative side effects of an earlier, oral or injectable form of the drug, such as diabetes and high blood pressure, explains Dr. Neil Schachter, professor of medicine at Mount Sinai Medical Center.
　　“Doctors are loathe to recommend them because they have the old image of the drug,"?Schachter says. “Some studies have shown only 30 percent of general physicians prescribe these medications correctly."?br /> 　　Researchers at the Royal Victoria Hospital in Montreal, Canada, looked back at the medical records of over 30,000 patients from 1975 through 1997. They report that for every additional canister of inhaled corticosteroids used during a year, a patient’s chance of dying of an asthma attack decreased 21 percent.

Risky Behavior
　　And patients who decide to forego their inhalers do so at their own risk.
　　“The risk of dying of asthma was five times as high for patients who stopped using their inhalers, compared to those who continued to use them,"?says Samy Suissa, Ph.D., professor of epidemiology at McGill University in Montreal. “Our recommendation is that patients should not interrupt or stop using them unless they consult their physician first."?br /> 　　These findings concur with an Israeli study published January 2000 in the Journal of Allergy and Clinical Immunology, which found similar results, according to a spokeswoman for the American Academy of Allergy, Asthma and Immunology.
　　“Physicians have a reluctance to use inhaled steroids because of concerns regarding potential adverse effects; patients have a reluctance to take them because of similar apprehensions,"?says Dr. Stanley J. Szefler, clinical research director for pediatrics at the National Jewish Medical and Research Center in Denver, Colo. “This study provides reassuring information on their benefits."?br /> 　　“Almost 6,000 people die of asthma each year, but the consensus is most of those deaths are unnecessary,"?Suissa says. “With this treatment, at low doses, we can save many of these lives."?br /> 　　But Dr. Gerald Teague, director of respiratory care at the Children’s Healthcare of Atlanta at Egleston in Atlanta, Ga., points out that even if inhaled steroids are proven effective, the problem remains: how to convince asthma sufferers to use them. “They are not accepted by many patients,"?he says, “and thus are not a proven solution to the current asthma crisis."?/p>

　　 (From ANCNEWS.com)