Is there anything in this world that has no ill effects ? Even water, when taken in excess has bad effects. I have recently started playing Badminton. That exercise is very good for my health, but it gives me aches and pains in the muscles. I have to accept that and tolerate it. Everything has benefits and risks. It’s a question of striking the right balance. Medicines or drugs also have both good and bad effects. Usually the good effects are many and the side effects are only minor and it would be prudent to accept that as part of the ” deal .”

Drugs used for asthma, like any other drug, can also cause side effects. Fortunately, many drugs for asthma are given by the inhaled route and hence the dose is greatly reduced and the drug only reaches the inner wall of the air tubes and therefore the bad effects are largely minimized. Yet, some unwanted or bad effects could happen.

Let us see in detail:

1. What are the common side effects of asthma medicines ?
2. How serious are these ?
3. Should one not take medicines because of this fear ?
4. What could be done to minimize the side effects ?

Quick relief medicines : Whether taken by inhaler (salbutamol) or as tablet (deriphyllin), all quick relief medicines cause tremors and palpitations (heart beating faster). Fortunately, this is not severe and is usually lasts only a few minutes to an hour and eventually the patient gets used to it.

Inhaled steroids : Oh the S…. Word !! Patients and parents of asthmatic kids are so afraid of this word. As if this is a poison. !! Are they safe? What is the truth?

Let me put before you a couple of facts:

• Steroids are a normal hormone of the body which is produced in the body everyday. It is, in fact, essential for life.
• When given through the inhaled route, only a small fraction of the microgram dose is absorbed in the blood stream.
• They are safe for pregnant women and in children.

When taken over prolonged periods, ie for years, they may cause some growth retardation in children and some early cataract and bone thinning in older adults. This could happen if the dose is more than the usual dose or in certain individuals who are exquisitely sensitive to steroids. Therefore, it is always wise to use the lowest dose of inhaled steroids that keeps the asthma under good control. The doctor would always try to reduce the dose once asthma symptoms are under good control. For this, regular – say, three monthly – monitoring is required.

Oral steroids: Oral steroids are reasonably safe for short courses , ie for up to 10-14 days, but not longer. Increasesd appetite, bloating, acidity and mental agitation may occur. These bad effects pass off soon on stopping the course. Since short courses are only required in an emergency, the good effects are far more than the bad ones.

Prolonged use of oral steroids is dangerous and should be avoided at all cost. I always maintain that ” bad doctors and bad patients have given steroids a bad name” as a result of which good patients will suffer the consequences of the disease by trying to avoid medicines.

So should one avoid taking asthma medicines because of the possibility of side effects? Most certainly not. The benefits of regular medicines are too many. The harms of allowing the disease to be unchecked are too many. If a few side effects do occur, it is very small price to pay for the many benefits.

What can be done to minimize the side effects ?

1. Use the minimum dose that works for you. Your doctor will help you to reduce the dose.
2. Always mouth rinse, do gargles and brush your teeth ( these are 3 different things ) after using the inhaled medication. This must be done if inhalers or nebulizers are being used. When inhaled medicine is used, a lot of it ( 70-80% ) is stuck in the mouth. This is inevitable. This is not useful for the patient because there is no disease in the mouth. On the other hand, this will get absorbed through saliva into the blood stream. Hence it must invariably be washed away with water.

So what is the bottom line ?

Medicines, like everything else in life, have both risks and benefits. Asthma tendency is usually lifelong. Unchecked asthmatic inflammation of the airways can permanently damage them. Medicines for asthma, as we have noted above, can have side effects. So the best thing would be to use medicines carefully so that the disease is also well controlled and yet there are no significant side effects. So we have to tread carefully the path that lies between the devil and the deep sea. Fortunately, this is relatively easily done for a majority of the patients.