Anti-Inflammatory Medications ("Preventers") for BPD
This section will provide information on preventer medications used in the treatment of BPD.
Note: All medications have a commercial name, and a chemical name (Generic products often use the chemical name). In this site, drugs' chemical names are given in brackets.
Disclaimer: No attempt has been made to list all anti-inflammatory medications - in general, preference has been given to preparations more commonly used in the Ottawa (Canada) area.
Tell Me More About Preventer Medications
There are two types of preventer (or anti-inflammatory) medications for BPD. They are the steroid-type preventer medications, and the non-steroid-type preventer medications.
Steroid-Type Preventer Medications
Why use Steroid-type Anti-Inflammatory Medications?
Steroids act directly on the inflammatory cells that cause inflammation in the lungs. They are the most consistently-effective preventer medications available. Studies show that lung inflammation starts in the first week of life, for premature babies receiving oxygen and/or mechanical ventilation. Recent studies have shown that steroids, started within the first several weeks of life, can decrease this inflammation, and often improve lung function.
The steroid medications used in BPD treatment are different from the anabolic steroids that have been mis-used by athletes, for example, in the Olympics.
Early on, in the transition period between RDS and BPD, steroids are usually given by injection or liquid. Steroids, given this way, are sometimes needed long-term in infants with more severe BPD. Injected or oral (given by mouth) liquid steroid medications are also used during periods of increased breathing difficulty.
In some infants and children, steroids given by inhaler are used for long-term reduction of lung inflammation, and to prevent attacks of difficulty breathing.
Oral Steroids
Steroids can be given by mouth or injected (known as "systemic steroids") are the most powerful medicines currently available for reducing inflammation. In general, they begin working in 1-2 days. Unfortunately, they have a higher risk for more serious side effects. Systemic steroids may be given regularly, on alternate days, or for short (3-7 day) periods during attacks of difficulty breathing. When used for a week or more, the dose is usually slowly tapered down over a varying period of time.
In Canada, commonly-used oral steroids include Prednisone, PediaPred® (Prednisolone), and Decadron® (Dexamethasone).
SIDE EFFECTS
- When used for short (3-7 day) periods, systemic steroids can cause mood changes, increased appetite, and weight gain. Serious side effects are uncommon.
- When used for long periods (many months or more), systemic steroids can cause reduced growth, thinning or softening of the bones, cataracts, high blood pressure, high blood sugar, difficulties dealing with stresses (like surgery), increased (and more severe) infections, poor or excessive weight gain, and, possibly, thickening of the walls of the heart. Because of these side effects, doctors use the minimum doses of these steroids for as short periods of time as possible, or attempt to replace these steroids by other anti-inflammatory medications. Because of the potential for these kinds of side effects, patients on long-term treatment with oral steroids are monitored closely by a doctor.
Inhaled Steroids
Inhaled steroids are designed to go directly to where they're needed (the lungs), with extremely little of the drug reaching the rest of the body. This lets inhaled steroids act as extremely effective preventer-type medications, while markedly reducing the risk of steroid-type side effects. Inhaled steroids are particularly helpful at reducing asthma attacks and attacks of asthma-like symptoms (wheezing and cough due to airway inflammation, excess mucous production, and bronchospasm).
Because inhaled steroids usually take 1-6 weeks to start working, inhaled steroids generally work best when taken on a regular basis. This fact also means that if your child is started on an inhaled steroid and isn't better after a couple of weeks, you shouldn't get discouraged. Obviously, if during this time, your child gets worse, you should notify your doctor. Inhaled steroids available in Canada include Vanceril® (Beclomethasone), Pulmicort® (Budesonide), FloVent® (Fluticasone), and Azmacort® (Triamcinolone). Inhaled steroids are available, depending on the medication, as puffers (Metered-Dose Inhalers), and for use in nebulizers.
SIDE EFFECTS
Most children using inhaled steroids experience no side effects at all.
- A few people have dry mouth, or throat irritation. This is usually minor.
- Inhaled steroids can cause Thrush in the mouth (little white patches, caused by a yeast infection). If this happens, it is usually treated with a special anti-yeast antibiotic. Thrush can be prevented by:
- Rinsing the mouth with some water (and, ideally, spitting the water out) after using the inhaled steroid inhaler;
- Using a spacer device (like the Aerochamber® or the ACE® spacer), so the heavier medicine particles released by the inhaler land in the spacer, rather than in the mouth.
- Very, very, rarely, inhaled steroids can cause a hoarse voice. If your child develops a hoarse voice for no good reason (such as a cold), you should let your doctor know, because the hoarseness can be important.
- The effect of inhaled steroids on growth are controversial. Children on inhaled steroids should have their growth carefully monitored. In our experience, most children on inhaled steroids grow just fine.
- Inhaled steroids may cause minor changes in the balance of natural steroid hormones which are produced by the body. Usually, this does not seem to be of any clinical significance.
Note that if your child is on inhaled steroids and your doctor recommends a course of oral steroid to control an attack of difficulty breathing, your child should take the oral steroid because it can prevent a severe attack of difficulty breathing.
Non-Steroid Preventer Medications
Non-steroid preventer medications interfere with either certain inflammatory cells in the lungs, or with the chemicals these cells release. This reduces lung inflammation, improving asthma control and preventing asthma and asthma-like attacks. The most commonly-used non-steroid preventer medication in Canada for BPD is Sodium Cromoglycate.
Note: Doctors sometimes call Aspirin® and Aspirin®-like drugs (like Motrin®) Non-Steroidal Anti-Inflammatory Drugs (or NSAIDs). NSAIDs are different from the Non-Steroid anti-inflammatory drugs discussed in this site. NSAIDs can actually worsen asthma in some asthmatics.
Sodium Cromoglycate
Sodium Cromoglycate is usually given on a long-term, regular basis to reduce inflammation. Sodium Cromoglycate takes 1-3 months to start working. This means that if your child is started on Sodium Cromoglycate and isn't better after a month or two, you shouldn't get discouraged. Obviously, if during this time, your child gets worse, you should notify your doctor. In Canada, the commercial name for Sodium Cromoglycate is Intal®. Sodium Cromoglycate is available as a puffer (or Metered-Dose Inhaler), and for use in a nebulizer.
COMMON USES OF SODIUM CROMOGLYCATE
- Sodium Cromoglycate is usually used as a preventer medication, on a long-term, regular basis.
SIDE EFFECTS
Sodium cromoglycate virtually never causes serious side effects.
- Sodium cromoglycate occasionally causes throat irritation, or dryness.