Jun 17, 2026 · 28 min · 11 segments
In episode 622, Jamie and James invite Émélie Braschi back again to talk about if we should be using inhalers that combine corticosteroids and beta-agonists as rescue inhalers. We go over the best…
Émélie BraschiGuestJames McCormackHost
Jamie FalkHost
Although once again, if you were going to follow the guideline, then you would probably use a little more, right? Yeah, exactly.
So, um, so one of the things is, is, uh, we're probably getting similar benefit from, uh, an as needed approach of the combination.
Yeah, so the overall side effects, I remember those were comparing different type of puffers were quite similar.
But do you want to chat about the side effects of inhaled corticosteroids, James?
No, but just know what they found and then we'll talk about them in general.
Well, they found that in theory, there was more adverse effects in the SABA-only group, but those were all asthma-related.
And I don't know what you guys do, but certainly if I was talking to someone about using inhaled corticosteroids, the comment I always say, You know, when you're using inhaled corticosteroids, you've got about a 5% chance of getting some sort of a fungal infection or thrush infection.
And I certainly know I've talked to a number of people who sing and have asthma who will not use steroids because it changes the tone of their voice.
I don't know if you guys have had those discussions, but those are the typical things I talk about.
Now, hopefully, if you use less, of the inhaled corticosteroids, you should have less side effects, but we don't really have studies that will tell you if it is less.
But is that what you guys talk about with your patients when it comes to inhaled corticosteroids?
Certainly when I, yeah, certainly when I, when I teach on, on these topics, uh, fresh and dysphonia would be, yeah, very similar, uh, incidence rates from the best that we can tell from side effect profiles.
One of the other things that I generally point out is potential risk of fractures as well, and this has been meta-analyzed.
It's not a common occurrence, so you've got to meta-analyze multiple RCTs for this, but we do have some data.
The numbers needed to treat are beyond or needed to harm, I guess it would be, are beyond 200.
So you've got to treat a lot of patients with generally, you know, these things tend to be dose related and there was a dose response curve in this.
Although once again, if you were going to follow the guideline, then you would probably use a little more, right? Yeah, exactly.
So, um, so one of the things is, is, uh, we're probably getting similar benefit from, uh, an as needed approach of the combination.
Yeah, so the overall side effects, I remember those were comparing different type of puffers were quite similar.
But do you want to chat about the side effects of inhaled corticosteroids, James?
No, but just know what they found and then we'll talk about them in general.
Well, they found that in theory, there was more adverse effects in the SABA-only group, but those were all asthma-related.
And I don't know what you guys do, but certainly if I was talking to someone about using inhaled corticosteroids, the comment I always say, You know, when you're using inhaled corticosteroids, you've got about a 5% chance of getting some sort of a fungal infection or thrush infection.
And I certainly know I've talked to a number of people who sing and have asthma who will not use steroids because it changes the tone of their voice.
I don't know if you guys have had those discussions, but those are the typical things I talk about.
Now, hopefully, if you use less, of the inhaled corticosteroids, you should have less side effects, but we don't really have studies that will tell you if it is less.
But is that what you guys talk about with your patients when it comes to inhaled corticosteroids?
Certainly when I, yeah, certainly when I, when I teach on, on these topics, uh, fresh and dysphonia would be, yeah, very similar, uh, incidence rates from the best that we can tell from side effect profiles.
One of the other things that I generally point out is potential risk of fractures as well, and this has been meta-analyzed.
It's not a common occurrence, so you've got to meta-analyze multiple RCTs for this, but we do have some data.
The numbers needed to treat are beyond or needed to harm, I guess it would be, are beyond 200.
So you've got to treat a lot of patients with generally, you know, these things tend to be dose related and there was a dose response curve in this.
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