Complications
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
Astma bij volwassenen: diagnose en monitoring in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Asthme chez l’adulte : diagnostic et surveillance en soins de santé primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020One case-control study found a dose-response relationship between both the cumulative dose and number of oral corticosteroid (OCS) and inhaled corticosteroid (ICS) prescriptions and risk of osteoporosis or fragility fracture in adult patients with asthma.[200] Patients receiving ≥9 OCS prescriptions within the previous year were 4.5 times more likely to develop osteoporosis than those who were not prescribed OCS. The same effect was observed with ICS but was less strong, with ≥11 ICS prescriptions in the previous year associated with a 1.6 times greater risk than no ICS. The results of this study highlight the importance of using the lowest possible doses of corticosteroids when indicated to maintain asthma control.[200] These results are consistent with those of a previous long-term observational study over more than 30 years (1984-2017).[201]
May occur in poorly controlled disease or if exposed to a major trigger (e.g., alternaria-allergic asthmatic people exposed to a high level of the allergen in a grain silo).
Can occur in any asthmatic after an upper airway infection or a persistent allergen exposure.
Counsel the patient on allergen removal and treat any upper or lower airway infection as necessary.
Exacerbation can be treated in the outpatient setting with an oral corticosteroid, and use of a short-acting beta agonist on an as-needed basis.
Patients should be instructed to go to the nearest emergency department if symptoms worsen. In the interim, the inhaled corticosteroid regimen should continue.
Pathologic changes affecting lung tissues as a result of persistent inflammation, causing a persistent irreversible airway obstruction.[198] This obstruction resembles that in COPD and may progressively worsen, limiting the activity of the patient.[199]
Those with more severe asthma may have a higher predilection for airway remodeling.
It is unknown what percentages have airway remodeling and, of those with remodeling, how many develop COPD.
The most common complication of using inhaled corticosteroids is oral candidiasis, often prevented by the use of a spacer tube, and rinsing, gargling, and spitting after inhaler use.
Another complication of using inhaled corticosteroids is dysphonia (i.e., laryngeal muscle spasm causing an abnormal voice), which can be prevented by changing the type of the inhaler.
On rare occasions, this may occur secondary to use of inhaled corticosteroids.
HIV serologies should be checked.
Treat with appropriate antifungal agents (e.g., fluconazole).
Use of this content is subject to our disclaimer