There is some evidence that sun exposure can accelerate steroid-induced skin atrophy, the development of which can be limited by protecting the skin, particularly the face and arms, from the sun. Daily use of a broad-spectrum sunscreen (UVB and UVA block) and appropriate protective clothing is recommended. 10 , 12 - 14 Patients on corticosteroids should also be encouraged to regularly use moisturisers on their arms and legs, as these may reduce bruising and tearing of the skin from minor trauma. 11 Evidence suggests that topical tretinoin can increase the epidermal thickness of sun-damaged atrophic skin, but long-term use may be necessary. 14 In dermatological practice, topical retinoids are used to help reverse skin atrophy caused by sun exposure or corticosteroid use.
Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
When used in high doses, a small amount of the medication is absorbed into the bloodstream and some side effects beyond the mouth and throat may develop. The most likely to be encountered are easy bruisability of the skin and suppression of the adrenal glands. The significance of adrenal gland suppression is discussed in further detail in the pamphlet entitled Asthma and Steroids in Tablet Form , prepared by the Partners Asthma Center. The risk from the long-term use of inhaled steroids in terms of hastening thinning of the bones (osteoporosis) is currently being studied. However, it is widely agreed that any risk that may be discovered will be far less than that resulting from use of steroids in tablet form in doses needed to achieve the same control of asthma.