Finnish study finds link between drugs used for severe asthma and serious illness

According to Professor Hannu Kankanranta, long-term and high-dose use of the drug may increase the risk of pneumonia due to weakening of the immune system. Newspaper photo / Kalle Parkin

A Finnish study found a link between cortisone-based asthma medications used to treat severe asthma and serious illnesses. In a comprehensive research project observed Especially the association of these drugs with pneumonia. For example, an association was found with osteoporosis, cataracts, obesity and heart failure.

Almost 30,000 Finns suffer from temporarily severe or persistent severe asthma. Asthma is an inflammatory lung disease whose common symptoms are cough, shortness of breath and wheezing.

– This risk is seen with high doses of inhaled steroids, a new finding in asthmatic patients, Professor Hannu Kankanranda, who worked on the research project, tells STT in a phone interview.

Inhaled steroids are inhaled asthma medications containing cortisone that are dosed and inhaled through an inhaler or commonly called an asthma tube. It is a basic asthma medication used by almost all asthmatics.

Previously, according to Kankanranta, it was considered that there was no additional risk of serious side effects when using it. Previous studies have found an increased risk of pneumonia in patients with COPD, but not in patients with asthma.

Kankanranda, who works as a professor at the University of Tampere and the University of Gothenburg, says the findings are of global importance as research brings new information about the treatment of asthma patients and the adverse effects of drugs.

Tablet users are also at risk

Research results show that people with severe asthma are nearly three times more likely to develop pneumonia compared to people with less severe asthma.

However, according to the study, the risk of serious diseases increases for those who use only high doses of inhaled steroids. Asthma tube users who survive small to moderate doses need not worry yet.

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High doses of inhaled cortisone medications are commonly used in patients with persistent severe or intermittent severe asthma.

A new finding is that there is an increased risk of pneumonia with the use of oral cortisone tablets, even from short continuous courses. They are used in the treatment of severe asthma.

– In such a situation, a course of cortisone tablets is still the basic treatment, but if the courses are repeated, there is also an increased risk of pneumonia and other diseases, he says.

In the study, higher use of cortisone tablets and the presence of various comorbidities were associated with increased visits to health care.

Asthma medicines are dispensed by Duodecim’s Health Library By Drugs that usually treat inflammation of the mucous membranes and drugs that open up the bronchial tubes. Drug therapy belongs to the basic treatment of asthma, while open medicines are used for occasional symptoms.

Inhaled steroids and cortisone tablets are the treatment asthma medications tested in the Finnish study.

The reason may be a weakened immune system

Inhaled inhaled steroids and tablets used in asthma exacerbations are cortisone-based medications. They calm asthma, but at the same time weaken the immune system. According to Kankanranda, the risk of pneumonia may increase with long-term and high-dose use of the drug because the immune system is weakened.

The professor adds that the increased risk of osteoporosis can be explained by the knowledge from studies that cortisone affects gene regulation. So far, why the use of asthma medications is associated with heart disease has remained a mystery.

– The link may be in weight gain, thereby increasing systemic inflammation, and then we can see an increase in heart disease, but we can’t say this directly, reflects Kankanranda.

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New treatments are needed

In the results of the study, the research team outlines that new treatments for severe asthma should be developed with steroid-based drugs, so that patients and the healthcare system are less affected by the burden of the disease.

Kankanranda insists that healthcare workers should be trained to avoid continuous or long-term courses of cortisone tablets.

– If the patient seems to need repeated courses, we will start to find out what is wrong and if we can find other treatment options for the patient, he adds.

According to Kankanranda, the same applies to inhaled, asthma drug therapy. If we get into a situation where we need to increase the dosage, the risks of other diseases will start to increase. If the drug causes additional co-morbidities, the health care burden is burdened and the asthma patient suffers.

– If the patient develops another disease as a side effect of asthma treatment, which requires treatment or causes problems, that is also difficult for the patient.

Biological drugs as a last resort

Other ways to treat asthma include long-acting drugs that can be used along with inhaled steroids, according to Kankanranda.

A last option is biologic drugs, which are antibodies against inflammatory mediators associated with asthma. With their help, the use of pill cortisone can be reduced or eliminated completely. Currently, this treatment is not suitable for all asthma patients.

– The patient must have a certain type of inflammation and fulfill certain conditions. Professor says they are very expensive drugs.

Don’t stop yourself from using it

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In the 2016 Finnish Asthma Study observed, patients often do not go for asthma screening. A follow-up visit should be done annually.

– It is important for patients to go for follow-ups because if they don’t, no one can intervene in the situation, Kanganranda emphasizes.

According to him, other things that can affect asthma are smoking, weight control and exercise.

– Smoking should be stopped as it causes problems in the long run. If you’ve piled on extra weight, it can be beneficial to gain some of it. Movement and taking care of your health are also important.

Despite the new information, Kankanranda stresses that you shouldn’t stop using an asthma tube containing an over-the-counter medication on your own. Stopping asthma medications on your own can lead to permanent deterioration of lung function. At worst, according to Kankanranda, it can lead to hospitalization or intensive care, even death.

Official records as sources of data

The results of a multi-year research project called Finasthma were published in January this year in The Journal of Allergy and Clinical Immunology, one of the leading publications in the research field. The study was funded by the pharmaceutical company GSK.

Information on more than 190,000 Finns with asthma was obtained from THL’s primary health care and specialist medical care treatment notification registries and the clinical data of KELA.

The study examined all Finns with asthma in the years 2014-2017.

Kankananda reminds us that based on the research, it is not possible to say whether the drug alone is responsible for the increased disease risk. However, a clear link was found.

Markus Polish chicken

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