When you meet a patient with asthma whose doctor has prescribed standardized asthma treatment medication, but the condition does not seem to improve, you ask the patient what is wrong? The patient often replies that the medication prescribed by the doctor contains hormones that make people gain weight, so he doesn’t dare to use it. He would rather have an asthma attack and go to the emergency room to hang saline than use the hormone-containing medication prescribed by his doctor. Do asthma patients really gain weight when they use hormones? Glucocorticoids are currently the most effective drugs for asthma treatment, but there are three major forms of hormones: oral, intravenous and inhaled. Among them, intravenous hormones are directly into the blood and are very effective for acute asthma attacks, which can quickly control the shortness of breath symptoms of asthma. Oral hormones have a similar effect, but because they need to be absorbed into the bloodstream through the gastrointestinal tract, they are slightly slower to work than intravenous hormones. Both hormones travel through the bloodstream and reach the lungs to exert their therapeutic effects, so we refer to intravenous and oral hormones collectively as systemic hormones. While systemic hormones exert their therapeutic effects, the hormones in the blood circulation also reach all organs of the body, so there are many, many side effects. Long-term use of systemic hormones can lead to a series of side effects such as reduced resistance to infection, osteoporosis and fracture, increased blood sugar and centripetal obesity (obesity of the face and trunk), etc. The side effects are not just “gaining weight”. In order to play the positive role of hormone treatment for asthma while avoiding the unavoidable side effects of systemic hormones, inhaled hormones were developed. Inhaled hormones deliver the medication directly to the inflammatory part of the lungs of asthma patients, without the need to go through the bloodstream, and therefore greatly reduce the side effects of hormones. Several currently used inhaled hormones are combined with bronchodilators (e.g., beta agonists), further reducing the amount of hormone application. Why are asthma patients so afraid of inhaled hormones? It is because they confuse intravenous hormones, oral hormones and inhaled hormones, thinking that inhaled hormones have the same side effects as systemic hormones. Let’s compare the amount of hormone that ends up in the bloodstream for both inhaled and systemic hormone forms. For the currently used budesonide/formoterol dry powder, the amount of hormone per inhalation is 160 micrograms per adult, twice a day, so the total amount of hormone per day is 320 micrograms. About 20-40% of the dry powder is inhaled into the lungs to take effect, and the rest is scattered in the oral pharynx, where we do not need the hormone, and most of it can be removed if you wash your mouth carefully to avoid local side effects in the mouth (such as mouth ulcers, etc.). The remaining part is swallowed and enters the gastrointestinal tract. Before these hormones enter the blood circulation, they have to be metabolized by the liver (medically known as “first pass effect”). Therefore, the amount of hormone that is finally absorbed into the circulation and may cause side effects is very small (microgram level)! This has been confirmed by the clinical practice of countless patients, who, although they inhale hormones regularly every day, have a very low incidence of systemic side effects, and “fattening” is rare. And systemic hormones, even one methylprednisolone (intravenous hormone), is 40 mg (milligram level! It is 1000 times more than micrograms) into the blood circulation. If patients do not follow medical advice for fear of “gaining weight” and do not apply inhaled hormones regularly even if they have frequent asthma symptoms, and pin their hopes on visiting the emergency room, getting rehydration fluids and hanging hormones, this is not only a waste of medical resources, but more importantly, the long-term application of systemic hormones will hurt your own body! In order to further reduce the side effects of inhaled hormones, doctors will control asthma symptoms with the lowest possible dose of hormones (including combined with other drugs, such as beta agonists, montelukast, etc.). Therefore, it is important for asthma patients to follow medical advice and adhere to standardized asthma treatment. Not only will your asthma be completely controlled, but the side effects of the medication will be minimized and you won’t have to worry about “gaining weight” at all.