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The Straight Dope 

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It's a miracle! No, I don't have stigmata, I haven't tasted a Circus Peanut and enjoyed it, and I haven't heard Steve Miller apologize for ripping off other artists. What has happened is that I've found relief for my asthma in a medication known as a steroid (Azmacort). I assume it's not the same kind of steroid that pumps up men and women with low self-esteem or athletes with no conscience. But what's the difference? Why am I being told there are no "side effects"? This sounds too good to be true.

--M. Kelly, Lansing, Michigan

I don't know about no side effects. Are they not counting blindness these days? Not that that's likely with careful use of steroid asthma inhalers. But if the message you heard was that inhalers have no side effects, you heard wrong.

Steroids are a lot like the Internet--versatile, dangerous in the wrong hands, and seemingly impossible to describe in comprehensible English. A typical encyclopedia account begins with the fascinating news that steroids are "any of a class of natural or synthetic organic chemical compounds characterized by a molecular structure of 17 carbon atoms arranged in four rings." Not to put too fine a point on it, but so freaking what? Eventually we get the picture: steroids are an important type of hormone, the chemicals by which the body regulates growth and other functions. Sex hormones, bile acids, vitamin D--they're all steroids. Ordinarily the body manufactures steroid hormones naturally (out of cholesterol, interestingly). For good reasons and bad, though, people sometimes hot-wire the system, dosing themselves with 'roids to get bigger muscles or, in your case, to continue breathing. The results are often dramatic. But over the long term, in some cases, the system fries.

You're right that the steroids in your inhaler aren't the same as the ones used by bodybuilders. All steroids are chemically similar (17 carbon atoms in four rings, remember?), but because of differences in the odd atom here and there they have widely varying effects. Anabolic (tissue-building) steroids, the kind some bodybuilders and athletes use, are basically synthetic testosterone. The glucocorticoids used in inhalers, on the other hand, are of a type produced by the adrenal cortex. High doses of glucocorticoids--much higher than the body normally produces--prevent the inflammation that causes asthma. But when taken in pill form they can also cause severe side effects, including suppression of the adrenal gland, cataracts, and osteoporosis.

Inhaled steroids, which became popular in the early 1990s, were thought to be safer than the pill kind because they acted directly on the lungs and weren't spread throughout the body. Today they're the mainstay of asthma therapy. Studies have shown that they greatly reduce the risk of hospitalization or death due to asthma. But in 1997 a Canadian study of 50,000 elderly found that long-term (greater than three months) high-dose use of steroid inhalers substantially increased the risk of glaucoma. Another study of 3,600 folks found that inhaled steroids increased the chances of developing cataracts. Some have disputed these results, and I don't mean to scare people off. Steroids clearly do control asthma. But I would definitely sit down with my doctor and discuss the risks. At a minimum I'd consider scheduling periodic eye exams. Steroids are powerful drugs, and you don't want to solve one problem only to create another.

Since you're looking into the origins of product names these days, here's one for you. Why do they call it 7 UP?

--Marilyn Clark, Country Club Hills, Illinois

Anything had to be an improvement over the original name: Bib-Label Lithiated Lemon-Lime Soda. Figuring that he was going to have a problem selling a product that you needed two years of speech therapy just to be able to pronounce, soda-pop mogul C.L. Grigg changed the name to 7 UP, apparently because the drink contained "seven natural flavors blended into a savory, flavory drink with a real wallop." You may wonder what the seven natural flavors were besides lemon and lime. I ain't saying. All I know is, I'm sure glad they dropped the horseradish.

A page of fun facts making the rounds says "I am" is the shortest complete sentence in English. Can this be true? --Jim Kepler, Chicago

No.

You object: "No" isn't a sentence! A sentence needs a predicate!

Oh, OK. Ready?

Go.

You object again: That's cheating! The subject is elliptical! Who could possibly call that a sentence?

I.

Art accompanying story in printed newspaper (not available in this archive): illustration by Slug Signorino.

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