Inhaled corticosteroids

Hearts Aflutter

Paul’s got it good. Throughout history Paul has been paid off by those who have borrowed from Peter. But you know how the story goes: It’s not Peter who comes out on the losing end.

In previous e-Alerts I’ve told you about a classic Peter/Paul situation when the use of inhaled corticosteroids (ICS) solves one problem while raising the risk of weakened bones. Now a new study demonstrates how yet another dangerous risk may be created for those who treat asthma, chronic obstructive pulmonary disease (COPD), allergies, arthritis and other conditions with high doses of ICS.

Out of balance

Individual case reports indicate that ICS use may trigger atrial fibrillation (AF), the most common type of abnormal heart rhythm, or arrhythmia. AF sharply increases the risk of heart failure and stroke.

To explore the association between ICS use and AF, researchers at Erasmus University in the Netherlands analyzed data collected from nearly 8,000 adults over the age of 55. During the nine-year study period, 385 subjects were diagnosed with new-onset AF. When this subgroup was compared to the others, researchers found a clear link between AF and high-dose use of ICS. No link was found in patients who used low or intermediate doses.

Writing in the current issue of the Archives of Internal Medicine, the authors note that the high levels of corticosteroids could set the stage for arrhythmia by throwing off the balance of potassium and sodium. ICS may cause sodium retention, setting up AF risk factors such as congestive heart failure and high blood pressure.

The bone factor

In the e-Alert “Could Your Asthma Inhaler Cause Osteoporosis?” (10/3/01), I told you about a Harvard study that showed how the regular use of inhaled steroids causes bone loss at the hip in women between the ages of 18 and 45. The more “puffs” taken each day, the greater the rate of bone loss. And while the study specifically focused on premenopausal women, it noted that continued ICS use after menopause could contribute to even more bone deterioration and greater risk of fracture.

But men don’t escape this risk. In a 2004 study that reviewed medical records for more than 40,000 subjects (almost all males) diagnosed with COPD, researchers identified about 1,700 cases of COPD patients with nonvertebral fractures, and matched them with more than 6,800 control subjects.

After a one-year follow-up, general ICS use was not associated with a higher fracture risk compared to patients who didn’t use inhalers. But fracture risk was found to be significantly elevated among those who used the highest dosages of ICS.

A little pressure

Fortunately there are alternative treatments and supplements that can be used to address COPD symptoms.

In the e-Alert “Heavy Breathing” (5/19/04), I told you about a condition called dyspnoea, characterized by shortness of breath or labored breathing, and is a typical symptom of COPD. Researchers in Taiwan conducted a study to examine the effects of acupressure in treating dyspnoea, and found pulmonary function and dyspnoea symptoms were considerably improved after just four weeks of acupressure.

And these improvements might be enhanced if patients take the right supplements. As HSI Panelist Allan Spreen, M.D., noted in a previous e-Alert: “Pity we can’t get all the asthmatics on food-allergy rotation diets, magnesium, and vitamins B-6, B-12, and C!”

In the e-alert “C-ing Stars” (6/12/02) I told you about a Nottingham University (UK) study that investigated the relationship between lung function and the intake of magnesium and vitamin C. Researchers surveyed more than 2,500 subjects to assess the relationship between diet and COPD. After nine years of follow-up, subjects who consumed higher amounts of vitamin C had better lung function than those with lower levels of C intake, and higher amounts of vitamin C and magnesium intake were associated with significantly improved lung function in the cases of those suffering from COPD.

Sources:
“More Support for Magnesium Against Colon Cancer” NutraIngredients, 1/31/06, nutraingredients.com