Steroids for asthma can destroy bone

Dear Dr. Roach: My wife had nasal polyps removed many years ago and within a year was diagnosed with adult asthma. She also contracted MAI several years ago, for which she was treated. In the past, she had one or two difficult periods of breathing, and her pulmonary doctor prescribed prednisone to get her through those severe times. When she develops a cough, more mucus builds up, and her breathing becomes a problem to the point that she can barely breathe and needs severe treatment.

The problem is that she also has severe osteoporosis, and all steroids are the worst thing she can take, as they destroy bone. She has been taking Advair daily since her original diagnosis. She has never been a smoker nor exposed to secondhand smoke.

Her conditions have worsened and she has almost died multiple times in the past two years due to her lung failure. She is not a candidate for a lung transplant, and we have not found anything to help her get better.

B.

Answer: You’ve identified two lung problems: asthma and MAC, which is mycobacterium avium complex, a lung infection similar to tuberculosis.

There are many newer asthma treatments that do not require prednisone, which absolutely is terrible for bones.

MAC can occur in people, usually middle-aged women, with no history of lung disease. Treatment is with two or three antibiotics and typically lasts 15 to 18 months.

However, I would be concerned that she has underlying lung disease, such as a chronic obstructive lung disease — which includes emphysema or chronic bronchitis — or bronchiectasis. Both of these have features that can be confused with or overlap with asthma.

Given that she was never a smoker, a diagnosis of emphysema or bronchiectasis by these tests would raise the suspicion of something like alpha-1 antitrypsin deficiency.

Once she has a firm diagnosis, she should hear about alternatives to steroid drugs. In the meantime, inhaled steroids are effective without causing much bone damage, and I hope she is on treatment to strengthen her bones.