Soothing patient and parent qualms about inhaled corticosteroids

The most recent guidelines of the National Asthma Education and Prevention Program Expert Panel for diagnosing and managing asthma declared that inhaled corticosteroids (ICS) are the preferred class of medication for treating asthma.1 However, physicians who prescribe ICS continue to meet with fear and resistance from patients and parents who are concerned about long-term use of corticosteroid medications. To address these concerns, I devised a dose-comparison chart, which I find relieves anxiety about using ICS.

I explain to parents and patients that a common prednisone burst for an asthma exacerbation is 40 mg po qd for five days, or 200 mg, which is 200,000 g, almost all of which is bioavailable.

This dosage is equivalent to:

200 days of Advair, 500/50 g q12h
200 days of Aerobid, 500 g bid
200 days of Pulmicort Respule, 0.5 mg bid
227 days Flovent, 440 g bid
250 days of Pulmicort Turbuhaler, 400 g bid
400 days of Advair, 250/50 g q12h
400 days of Pulmicort Respule, 0.25 mg bid
454 days of Flovent, 220 g bid
500 days of Azmacort, 200 g bid
625 days of QVAR, 160 g bid
1,000 days of Advair, 100/50 g q12h
1,136 days of Beclovent/Flovent/Vanceril, 88 g bid
1,250 days of QVAR, 80 g bid

(Only 1% to 6% of each medication listed above is bioavailable.)

We can, of course, talk to our patients about risk factors and safety studies, but sometimes a simple comparison is more meaningful. Questions about ICS safety have ceased since I introduced the above information as a handout in my practice.

Paul S. Salva, MD, PhD
Springfield, Mass.

(Contemporary Pediatrics, 9/03)