AD
begin quote from:
https://www.cnn.com/2022/08/30/health/oral-inhaled-steroids-brain-changes-wellness/index.html
Common steroids used for asthma, allergies linked to brain decline, study finds
By Sandee LaMotte, CNN
Updated 6:31 PM ET, Tue August 30, 2022
Photos: Allergy-proof your day
Take a breather – Research shows that stress can aggravate allergic reactions, even a full day after an anxiety-producing event. That might be because as stress hormones in your body rise, so do levels of cytokines -- proteins we produce as part of the allergic response, according to research from Ohio State University.
To keep an even keel during allergy season, soothe yourself by breathing deeply, listening to tunes you love or working out.
To keep an even keel during allergy season, soothe yourself by breathing deeply, listening to tunes you love or working out.
Hide Caption
6 of 11
Photos: Allergy-proof your day
LImit outdoor runs to the afternoon – If you prefer to run or walk outdoors, do so in the afternoon, when pollen counts are lower, Tubiolo advises. But if your allergies are really bad, you're better off sticking with the gym or at-home workouts.
Health.com: Home remedies for allergies: What works?
Health.com: Home remedies for allergies: What works?
Hide Caption
7 of 11
Photos: Allergy-proof your day
Kick off your shoes at home – This will prevent you from tracking pollen all over the house. Better yet, strip off your clothes and hop in the shower so pollen doesn't linger on your hair and body. Run the bathroom fan to keep humidity levels down and prevent mold spores -- another allergy trigger -- from taking hold.
Hide Caption
8 of 11
Photos: Allergy-proof your day
Eat salmon – Participants in a German study who consumed the highest amount of a type of omega-3 fatty acid called EPA (found in fatty fish, like salmon) had a lower risk of developing hay fever. This substance might quash allergy symptoms by reducing inflammation in the body, Ogden says.
Don't eat fish regularly? Taking an omega-3 supplement with EPA can also help, she says.
Don't eat fish regularly? Taking an omega-3 supplement with EPA can also help, she says.
Hide Caption
9 of 11
Photos: Allergy-proof your day
Keep Fido and Kitty off your bed – Long-haired pets that spend time outside can drag pollen back in with them, Ogden says.
Health.com: 15 hypoallergenic dogs and cats
Health.com: 15 hypoallergenic dogs and cats
Hide Caption
10 of 11
Photos: Allergy-proof your day
Pop a 24-hour allergy pill before bed – That's right -- before bed. Some antihistamines can make you drowsy. Plus, many of them take an hour or two to kick in, Tubiolo explains. That means they'll start working while you're asleep and you'll be symptom-free when you step out the door.
Health.com: Your secret allergy triggers revealed
Health.com: Your secret allergy triggers revealed
Hide Caption
11 of 11
Photos: Allergy-proof your day
Allergy-proof your day – Now that hay fever season has hit, your first instinct might be to pop an antihistamine. It's not a bad one: "If you have allergies, one of the best things you can do is start medications early, even before your symptoms kick in," says Dr. Neeta Ogden, an allergist in New York.
But, she adds, it's also crucial to make tweaks to your daily routine to avoid whatever sparks your symptoms. Read on for easy, effective ways to keep sniffles at bay 24/7.
But, she adds, it's also crucial to make tweaks to your daily routine to avoid whatever sparks your symptoms. Read on for easy, effective ways to keep sniffles at bay 24/7.
Hide Caption
1 of 11
Photos: Allergy-proof your day
Keep your windows shut – Tree and grass pollen -- the main causes of spring allergies -- can blow into your house if you open your windows even a crack, "especially during the early morning hours, when tree pollen counts are typically the highest," says Dr. Vincent Tubiolo, an allergy, asthma and immunology specialist in Santa Barbara, California.
Stuffy inside? Run the air conditioning, but change your filters before each season to remove pollen, dust and mold. If you're really suffering, invest in an air purifier with a HEPA filter to help suck up lingering allergens.
Stuffy inside? Run the air conditioning, but change your filters before each season to remove pollen, dust and mold. If you're really suffering, invest in an air purifier with a HEPA filter to help suck up lingering allergens.
Hide Caption
2 of 11
Photos: Allergy-proof your day
Check the pollen count – Visit weather sites, watch your local morning news or download the Pollen.com app for your phone. If the count is high, try to stay indoors as much as possible, Ogden advises.
Health.com: Are you making these allergy mistakes?
Health.com: Are you making these allergy mistakes?
Hide Caption
3 of 11
Photos: Allergy-proof your day
Sport shades – Sunglasses physically block airborne allergens from blowing into -- and irritating -- your eyes, especially on windy days.
Health.com: 10 worst plants for your allergies
Health.com: 10 worst plants for your allergies
Hide Caption
4 of 11
Photos: Allergy-proof your day
Snack on yogurt – People who consumed a yogurt drink containing the probiotic Lactobacillus casei once a day for five months had lower levels of an antibody that produces allergy symptoms, according to a study from the Institute of Food Research in the United Kingdom. Researchers are now looking into whether that might actually lessen the severity of those symptoms.
In the meantime, it couldn't hurt to take probiotic supplements or eat yogurt regularly. Check the label to see if a product contains L. casei.
In the meantime, it couldn't hurt to take probiotic supplements or eat yogurt regularly. Check the label to see if a product contains L. casei.
Hide Caption
5 of 11
Photos: Allergy-proof your day
Take a breather – Research shows that stress can aggravate allergic reactions, even a full day after an anxiety-producing event. That might be because as stress hormones in your body rise, so do levels of cytokines -- proteins we produce as part of the allergic response, according to research from Ohio State University.
To keep an even keel during allergy season, soothe yourself by breathing deeply, listening to tunes you love or working out.
To keep an even keel during allergy season, soothe yourself by breathing deeply, listening to tunes you love or working out.
Hide Caption
6 of 11
Photos: Allergy-proof your day
LImit outdoor runs to the afternoon – If you prefer to run or walk outdoors, do so in the afternoon, when pollen counts are lower, Tubiolo advises. But if your allergies are really bad, you're better off sticking with the gym or at-home workouts.
Health.com: Home remedies for allergies: What works?
Health.com: Home remedies for allergies: What works?
Hide Caption
7 of 11
Photos: Allergy-proof your day
Kick off your shoes at home – This will prevent you from tracking pollen all over the house. Better yet, strip off your clothes and hop in the shower so pollen doesn't linger on your hair and body. Run the bathroom fan to keep humidity levels down and prevent mold spores -- another allergy trigger -- from taking hold.
Hide Caption
8 of 11
Photos: Allergy-proof your day
Eat salmon – Participants in a German study who consumed the highest amount of a type of omega-3 fatty acid called EPA (found in fatty fish, like salmon) had a lower risk of developing hay fever. This substance might quash allergy symptoms by reducing inflammation in the body, Ogden says.
Don't eat fish regularly? Taking an omega-3 supplement with EPA can also help, she says.
Don't eat fish regularly? Taking an omega-3 supplement with EPA can also help, she says.
Hide Caption
9 of 11
Photos: Allergy-proof your day
Keep Fido and Kitty off your bed – Long-haired pets that spend time outside can drag pollen back in with them, Ogden says.
Health.com: 15 hypoallergenic dogs and cats
Health.com: 15 hypoallergenic dogs and cats
Hide Caption
10 of 11
Photos: Allergy-proof your day
Pop a 24-hour allergy pill before bed – That's right -- before bed. Some antihistamines can make you drowsy. Plus, many of them take an hour or two to kick in, Tubiolo explains. That means they'll start working while you're asleep and you'll be symptom-free when you step out the door.
Health.com: Your secret allergy triggers revealed
Health.com: Your secret allergy triggers revealed
Hide Caption
11 of 11
Photos: Allergy-proof your day
Allergy-proof your day – Now that hay fever season has hit, your first instinct might be to pop an antihistamine. It's not a bad one: "If you have allergies, one of the best things you can do is start medications early, even before your symptoms kick in," says Dr. Neeta Ogden, an allergist in New York.
But, she adds, it's also crucial to make tweaks to your daily routine to avoid whatever sparks your symptoms. Read on for easy, effective ways to keep sniffles at bay 24/7.
But, she adds, it's also crucial to make tweaks to your daily routine to avoid whatever sparks your symptoms. Read on for easy, effective ways to keep sniffles at bay 24/7.
Hide Caption
1 of 11
Photos: Allergy-proof your day
Keep your windows shut – Tree and grass pollen -- the main causes of spring allergies -- can blow into your house if you open your windows even a crack, "especially during the early morning hours, when tree pollen counts are typically the highest," says Dr. Vincent Tubiolo, an allergy, asthma and immunology specialist in Santa Barbara, California.
Stuffy inside? Run the air conditioning, but change your filters before each season to remove pollen, dust and mold. If you're really suffering, invest in an air purifier with a HEPA filter to help suck up lingering allergens.
Stuffy inside? Run the air conditioning, but change your filters before each season to remove pollen, dust and mold. If you're really suffering, invest in an air purifier with a HEPA filter to help suck up lingering allergens.
Hide Caption
2 of 11
Photos: Allergy-proof your day
Check the pollen count – Visit weather sites, watch your local morning news or download the Pollen.com app for your phone. If the count is high, try to stay indoors as much as possible, Ogden advises.
Health.com: Are you making these allergy mistakes?
Health.com: Are you making these allergy mistakes?
Hide Caption
3 of 11
Photos: Allergy-proof your day
Sport shades – Sunglasses physically block airborne allergens from blowing into -- and irritating -- your eyes, especially on windy days.
Health.com: 10 worst plants for your allergies
Health.com: 10 worst plants for your allergies
Hide Caption
4 of 11
Photos: Allergy-proof your day
Snack on yogurt – People who consumed a yogurt drink containing the probiotic Lactobacillus casei once a day for five months had lower levels of an antibody that produces allergy symptoms, according to a study from the Institute of Food Research in the United Kingdom. Researchers are now looking into whether that might actually lessen the severity of those symptoms.
In the meantime, it couldn't hurt to take probiotic supplements or eat yogurt regularly. Check the label to see if a product contains L. casei.
In the meantime, it couldn't hurt to take probiotic supplements or eat yogurt regularly. Check the label to see if a product contains L. casei.
Hide Caption
5 of 11
Photos: Allergy-proof your day
Take a breather – Research shows that stress can aggravate allergic reactions, even a full day after an anxiety-producing event. That might be because as stress hormones in your body rise, so do levels of cytokines -- proteins we produce as part of the allergic response, according to research from Ohio State University.
To keep an even keel during allergy season, soothe yourself by breathing deeply, listening to tunes you love or working out.
To keep an even keel during allergy season, soothe yourself by breathing deeply, listening to tunes you love or working out.
Hide Caption
6 of 11
(CNN)Taking oral or inhaled glucocorticoids, a type of steroid used to curb inflammation in asthma and other autoimmune disorders, may be linked to damaging changes in the white matter of the brain, a new study found.
"This study shows that both systemic and inhaled glucocorticoids are associated with an apparently widespread reduction in white matter integrity," wrote study author Merel van der Meulen, a postdoctoral student at Leiden University Medical Center in the Netherlands, in the study published Tuesday in the journal BMJ Open.
White matter is the tissue that forms connections between brain cells and the rest of the nervous system. Having less white matter can slow the brain's ability to process information, pay attention and remember. Lower levels of white matter have also been connected to psychiatric issues such as depression, anxiety and irritability.
"This new study is particularly interesting in showing the extent to which white matter, which is required for neurons to connect with each other, is affected by medication use," said Thomas Ritz, a professor of psychology at Southern Methodist University who has researched the impact of steroids on people with asthma. He was not involved in the study.
However, "there's no reason for alarm," said neuroimmunologist Dr. Avindra Nath, the clinical director of the National Institute of Neurological Disorders and Stroke, who was also not involved in the study. Doctors have long known that, if you give patients steroids, "the brain does shrink, but when you take them off the steroids, it comes back," Nath said.
Due to brain plasticity -- the ability of the brain to reorganize its structure, functions or connections -- "these could be temporary effects," he said. "They don't necessarily have to be permanent. White matter can repair itself."
Widespread use
Glucocorticoids are some of the most frequently prescribed anti-inflammatory medications due to their widespread use in a number of conditions, experts say.
Enter your email to sign up for the Stress, but less newsletter.
close dialog
In addition to asthma, both oral and inhaled glucocorticoids can be used to treat allergies, chronic obstructive pulmonary disease (COPD), Crohn's disease and other types of inflammatory bowel disease, eczema and other skin conditions, lupus, tendinitis, multiple sclerosis, osteoarthritis, and rheumatoid arthritis.
Don't confuse glucocorticoid inhalers like this with rescue inhalers, which contain a different type of medication.
However, glucocorticoid inhalers should not be confused with quick-relief inhalers used to stop an asthma attack. Quick-relief inhalers contain non-steroid medications that relax the muscles in the lungs, such as albuterol, levalbuterol and pirbuterol, which can open airways in minutes. Inhaled corticosteroids do not work in emergencies -- they are prescribed for longer-term control of inflammatory conditions.
Prior research has linked the long-term use of oral glucocorticoids to structural brain abnormalities and shrinkage of certain areas of the brain, as well as mental health issues such as anxiety, depression, confusion and disorientation. Studies have also shown that people who have lived with asthma have higher rates of cognitive and memory impairment later in life than people without the condition.
But much prior research has been small in scale, and at times, inconclusive, experts say.
The new study used data from the UK BioBank, a large biomedical research center that followed 500,000 residents of the United Kingdom from 2006 to 2010. From that database, the researchers were able to find 222 oral glucocorticoid users and 557 users of inhaled glucocorticoids who did not have a previous diagnosis of any neurological, hormonal or mental health disorder.
Those people underwent cognitive and mental health testing and received a diffusion MRI of the brain. Researchers pulled that data and compared those MRI and cognitive findings to over 24,000 people in the database who did not use steroids.
"To the best of our knowledge, this is the largest study to date assessing the association between glucocorticoid use and brain structure, and the first to investigate these associations in inhaled glucocorticoid users," wrote the study authors.
Inhalers had smallest impact
The study found the greatest amount of white matter damage in people who use oral steroids regularly over long periods of time. The mental processing speed of chronic oral steroid users tested lower than non-users. People on oral steroids also had more apathy, depression, fatigue and restlessness than non-users of steroids.
The smallest impact on white matter occurred in people who use inhaled steroids, the study found.
That fits with what doctors see in clinical practice, said pulmonologist Dr. Raj Dasgupta, an assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California. He was not involved in the study.
"We don't see side effects as often with the inhaled form of glucocorticoids," he said. "And of course, mainstay of therapy for allergies and asthma is always going to be avoiding the triggers and making lifestyle modifications."
Pulmonologists and rheumatologists are cautious about prescribing the smallest dose of steroids needed to control symptoms, Dasgupta said, due to the large number of side effects from steroid use that can also impact health, including brain health.
"As a clinician, the minute you start a person on these medications, you're immediately thinking, 'How do I safely take that person off in a timely fashion?' Steroids cause weight gain, and weight gain is always going to be a risk for developing diabetes and high blood pressure,d" Dasgupta said.
"When you give steroids to people with diabetes, their blood sugar can go up," he added. "When you take steroids acutely, you could definitely have insomnia and trouble sleeping, and when you're on long-term steroids, it puts you at a high risk for infections because they are an immunosuppressant."
More research needed
The new study had limitations. For one, it was not able to determine steroid dose or track adherence, Ritz said.
"We know that only about 50% of patients with asthma take their medication as prescribed, and potential overreporting of intake is also an issue," Ritz said. "You should take your inhaled corticosteroids, which reduce the inflammation locally, as regularly as possible, albeit at the lowest possible dose that allows you to control you asthma.
"This study gives us another reason to keep the dosages low," he added.
Another limitation was that it was unable to differentiate between people who take steroid tablets and those who use infusions, according to study authors.
"The study mainly confirms what we know for a long time in asthma management: Take as few systemic (oral) corticosteroids as possible, as long as you are not a patient with severe asthma. Stick to inhaled steroids and discuss with your treating physician plans to step down medication regimens during good times," Ritz said.
"It's a very well done study," Nath said. "But the findings demand another study to be done to see how long these effects last and how they can be reversed."
No comments:
Post a Comment