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Long-Term Effects of Overuse of an Inhaler for Asthma

author image Tanya Feke
Tanya Feke is a board-certified family physician with interests in preventive medicine, lifestyle modification and women's health. Her book "Medicare Essentials" is an Amazon bestseller. She has been published in the journal "Medical Economics" and has managed her educational website Diagnosis Life ( since 2010.

Taking a medicine more frequently or at higher doses than is prescribed without consulting a doctor is not a good idea -- and most people know this. However, what exactly are the long-term risks of overusing an asthma inhaler? Well, it depends on what, specifically, is being overused. ... [Continue here to preview what you are going to talk about very generally -- but don't state anything here that you would restate later.]

Types of inhaled asthma medications

Two classes of inhaled asthma medications are commonly prescribed in the treatment of asthma: Beta2 (β2)-agonists and corticosteroids. Both classes are considered safe as long as they are taken as directed.

Short-acting β2-agonists

Short acting β2-agonists, sometimes called rescue inhalers, relax and dilate airways to increase airflow. Short-acting β2-agonists such as albuterol and terbutaline provide immediate relief of airway constriction that lasts up to 8 hours. Clinicians commonly refer to this class of drugs as “rescue therapy” because it should only be administered during acute attacks. β2-agonists are considered safe as long as they are not being used more than twice a week (except in exercised-induced asthma). The National Heart, Lung and Blood Institute cautions that overuse of short-term β2-agonists indicates that asthma is not well-controlled and that the current treatment plan must be re-evaluated. Patients who exceed dosing recommendations may experience worsening and reduced control of asthma symptoms.

Long-term β2-agonists

Long-term β2-agonists, such as salmeterol and formotoerol, also increase airflow to the lungs by relaxing and dilating airways. They provide up to 12 hours of relief from airway constriction. The Salmeterol Multicenter Asthma Research Trial (SMART) investigated the safety of long-term β2-agonists and demonstrated that they should not be prescribed as a monotherapy due to: • Increased risk of asthma-related death and life-threatening events • Reduced response to rescue therapy • Cardiovascular side effects that increase with duration of use, including increased heart rate, palpitations, arrhythmias and congestive heart failure β2-agonists are however considered safe when prescribed in conjunction with low-dose inhaled corticosteroids.

Inhaled corticosteroids

Inhaled corticosteroids improve asthma symptoms by decreasing airway inflammation. They provide long-term asthma control when prescribed alone or in combination with long-term β2-agonists as maintenance therapy. Corticosteroids are generally considered safe in low-to-medium doses; however, extended use of higher doses in children have been linked to: • Suppression of hypothalamus, pituitary and adrenal gland function • Reduced growth rate and lower adult height

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