PC: CNN Philippines
According to a recent study, the use of oral or inhaled glucocorticoids, a class of steroids used to treat asthma and other inflammatory diseases by reducing inflammation, may cause harmful alterations in the brain’s white matter.
This study, led by Merel van der Meulen, a postdoctoral fellow at Leiden University Medical Center in the Netherlands, and published on Tuesday in the journal BMJ Open, “shows that both systemic and inhaled glucocorticoids are associated with an apparently widespread reduction in white matter integrity.”
The tissue known as “white matter” is what connects brain cells to the rest of the nervous system. The brain’s capacity to process information, pay attention, and recall can be slowed by having less white matter. Lower white matter volumes have also been linked to psychiatric conditions such anxiety, depression, and irritability.
Thomas Ritz, a psychology professor at Southern Methodist University who has studied the effects of steroids on people with asthma, said that the new study is particularly intriguing because it demonstrates how medication use affects white matter, which is necessary for neurons to connect with one another. He wasn’t a part of the investigation.
But according to neuroimmunologist Dr. Avindra Nath, clinical director of the National Institute of Neurological Disorders and Stroke, who was also not involved in the study, “there’s no reason for panic,” The brain does shrink when patients are given steroids, but it returns when the steroids are stopped, doctors have long known, according to Nath.
These “may be transient impacts,” he said, referring to the brain’s capacity to restructure its connections, functions, and structure. “They don’t always have to be long-term. White matter is capable of healing.”
Due to their widespread use in a variety of illnesses, specialists suggest that glucocorticoids are among the most often prescribed anti-inflammatory drugs.
Allergies, chronic obstructive pulmonary disease (COPD), Crohn’s disease and other forms of inflammatory bowel disease, eczema and other skin conditions, lupus, tendinitis, multiple sclerosis, osteoarthritis, and rheumatoid arthritis can all be treated with oral and inhaled glucocorticoids in addition to treating asthma.
However, quick-relief inhalers used to halt an asthma attack should not be mistaken with glucocorticoid inhalers. Albuterol, levalbuterol, and pirbuterol are examples of non-steroid drugs found in quick-relief inhalers that relax the lungs’ muscles and can quickly open airways. Inhaled corticosteroids are indicated for longer-term management of inflammatory diseases; they are ineffective in crises.
Prior studies have connected long-term oral glucocorticoid use to structural abnormalities in the brain, atrophy of certain brain regions, and mental health conditions such anxiety, depression, confusion, and disorientation. Additionally, research has indicated that asthma sufferers are more likely than non-asthmatics to experience cognitive and memory decline in later life.
However, many earlier studies have been limited in scope and occasionally inconclusive, according to specialists.
The UK BioBank, a sizable biological research facility that tracked 500,000 UK citizens from 2006 to 2010, provided the data for the current study. The researchers were able to identify 222 oral glucocorticoid users and 557 inhaled glucocorticoid users in that database who had never been diagnosed with a neurological, hormonal, or mental health condition.
These individuals had evaluations of their cognitive and mental health as well as a diffusion MRI of the brain. Researchers took that information and compared it to the cognitive and MRI results of over 24,000 non-steroid users in the database.
According to the study’s authors, this is the largest study to date examining the relationship between glucocorticoid use and brain anatomy. It is also the first to look into these relationships in people who use inhaled glucocorticoids.
Inhalers made the least difference
The study discovered that those who consistently use oral steroids for extended periods of time have the most severe white matter damage. Chronic oral steroid users evaluated slower in terms of mental processing speed than non-users. Additionally, apathy, despair, weariness, and restlessness were more common among oral steroid users than in non-users.
The study discovered that inhaling steroids had the slightest effect on white matter.
According to pulmonologist Dr. Raj Dasgupta, an assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California, it is consistent with what medical professionals observe in clinical practise. He wasn’t a part of the investigation.
He said that the inhaled form of glucocorticoids didn’t cause negative effects as frequently. Of course, avoiding triggers and changing one’s lifestyle will always be the cornerstones of treatment for allergies and asthma.
According to Dasgupta, due to the numerous adverse effects of steroid use that can also affect health, particularly brain health, pulmonologists and rheumatologists are cautious about prescribing the smallest dose of steroids required to control symptoms.
“When you start a patient on one of these drugs, your first thought as a doctor is always, “How do I safely wean that patient off in a timely manner?” Weight gain is a side effect of steroids and will always increase the risk of getting diabetes and high blood pressure “said Dasgupta.
He continued, “When you give steroids to diabetics, their blood sugar can go up. “When you use steroids acutely, you may experience sleeplessness and sleep problems, and because they depress the immune system, long-term steroid use puts you at a significant risk for infections.”
More study is required
The new study was constrained. For starters, Ritz said, it was unable to calculate the dosage of steroids or monitor adherence.
According to Ritz, “possible overreporting of intake is also a problem. We know that only around 50% of asthma patients take their medication as directed. “You should take your inhaled corticosteroids as frequently as you can, albeit at the lowest dose that enables you to control your asthma. They work locally to reduce inflammation.
This study provides us with another more reason to maintain low dosages, he continued.
The inability to distinguish between users of infusions and those who use steroid tablets is another drawback, according to the study’s authors.
“As long as you do not have severe asthma, the study basically validates what we have known for a long time about managing asthma: Use as little systemic (oral) corticosteroids as feasible. Keep to inhaled steroids, and discuss with your doctor how you intend to reduce your drug dosages when things are going well “explained Ritz.
Nath remarked, “It’s a pretty nicely done study. However, the results call for additional research to be conducted to determine how long these effects continue and how they can be reversed.