New Delhi: Asthma patients on long-term inhalers who undergo spine surgery may face a higher risk of repeat operations, a new international study has found.The study, led by researchers at Johns Hopkins University with collaborators including AIIMS Delhi, has found that patients on regular inhaled steroids were over three times more likely to require another surgery after spinal fusion compared to those not using them.Researchers said the asthma itself did not increase the risk. Instead, long-term use of steroid-based inhalers appeared to be the key factor affecting outcomes after surgery. Patients not on these medicines had results similar to those without asthma.While the impact of long-term oral steroids on bone healing is well known, researchers said the effects of inhaled steroids on spine surgery outcomes have been less clear so far.Doctors explained that spinal fusion surgery depends on proper bone healing, and long-term steroid use can weaken bones and slow healing, and increase the chances of complications or repeat procedures.One of the researchers, professor Bhavuk Garg of AIIMS, said that even inhaled steroids, long considered safe, may subtly compromise bone health and spinal fusion outcomes. “In a country like India, where both asthma and osteoporosis are under-recognised, this calls for careful pre-operative evaluation and optimisation. This is not about stopping asthma treatment, but about smarter spine care —identifying at-risk patients early and optimising bone health before surgery to improve outcomes,” he said, adding that the findings are particularly relevant given rising air pollution and a growing elderly population.The study also found higher rates of problems such as poor bone fusion and implant-related issues among patients using inhalers, pointing to possible underlying bone weakness. However, researchers stressed that the findings show a link, not a direct cause.Experts said the findings are important for patients planning spine surgery, suggesting the need to assess bone health and carefully manage treatment in those on long-term inhalers.Inhaled steroids remain essential for asthma control, but doctors say patients should continue them under medical guidance, especially if surgery is planned.
