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Prednisone dose for asthma exacerbation
- Prednisone for Asthma: Usage, Efficacy, and More
Until recently, regular use of OCS was often the only effective option for those with severe disease that could not be controlled with the previous steps. Contemporary research has therefore focused on optimal dosing, and a Cochrane review has confirmed that OCS treatment that is titrated based on sputum eosinophil counts results in reductions in exacerbation rates compared with dosing based on clinical markers alone.
When used appropriately, these biological agents are effective at reducing exacerbations and improving symptoms and control. To date, even with the introduction of the new biological agents, there remains a prominent role for OCS in the management of severe asthma.
In the setting of the anti-IgE agent omalizumab for severe allergic asthma, in one review omalizumab has not been shown to allow a dose reduction in OCS. The remaining patients continued to use OCS, although at lower doses than at the onset of the study. Therefore, the experience, at least so far, with the biological agents has been that continued use of OCS is likely to remain important in a large proportion of patients with severe asthma, and even in the setting of these novel biological therapies, there is still a role for long term treatment with OCS as adjunctive therapy.
Further study is required to determine why this may be the case, but it may be due to the multiple pathways through which corticosteroids have an anti-inflammatory effect in asthma. Nevertheless, given the potential adverse effects with OCS, it is hoped that this role will be reduced in the presence of biological agents. Despite the long history of OCS use in severe asthma, there are no studies that have determined the optimal duration or dose to control the disease.
Although titrating OCS to target normalisation of biomarker values has shown promise in a pilot study, 32 the optimal way to use these markers will require more definitive evidence. The population with severe asthma is the last major cohort of patients with asthma who continue to be treated with long term maintenance OCS, and no discussion of the role of OCS would be complete without acknowledging the significant long term side effects of treatment which have been recognised since their early initial use in the s.
The most common serious complications include: bone density loss and risk of fracture, weight gain and metabolic syndrome, adrenal suppression and relative immunosuppression. In particular, the use of bisphosphonates to prevent osteoporosis is recommended, and gastric ulcer prophylaxis should be considered for those patients at risk.
The most well defined and frequent use of OCS in the management of severe asthma is during an asthma exacerbation. The current Global Initiative for Asthma guidelines suggest that an asthma exacerbation is a progressive increase in symptoms sufficient to require a change of treatment. In one study in patients with moderate to severe asthma, the frequency of eosinophilic exacerbations was reduced by OCS, whereas non-eosinophilic exacerbations, which were the most common type, were not reduced.
In summary, OCS continue to play an important role in the management of severe asthma. In spite of their well known and significant side effects, they remain a crucial element in the management of this disease. Even with the availability of the novel biological therapies targeting IgE and IL-5, a large proportion of patients will continue to require OCS to control their asthma. This situation is unlikely to change in the near future. Further work should explore ways to optimise the balance between their efficacy and their safety.
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Article type. Author's surname. First page. Issues by year. Article types. Research letters. Guidelines and statements. Narrative reviews. Ethics and law. Medical education. Volume Issue 2 Suppl. Appropriate use of oral corticosteroids for severe asthma. Med J Aust ; 2 : SS Topics Respiratory tract diseases.
Endocrine system diseases. Immune system diseases. Summary Severe asthma represents a significant burden of disease, particularly in high income nations; oral corticosteroids OCS remain an important part of the management toolkit for these patients.
History of oral corticosteroids use in asthma Before the s, the treatment for asthma was restricted to those compounds that were either plant-derived or adrenaline derivatives.
Oral corticosteroids in the management of acute exacerbation of asthma The most well defined and frequent use of OCS in the management of severe asthma is during an asthma exacerbation. Conclusion In summary, OCS continue to play an important role in the management of severe asthma. View this article on Wiley Online Library. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment.
Respir Med ; Eur Respir J ; Economic burden of asthma: a systematic review. BMC Pulm Med ; 9: After asthma: redefining airways diseases.
Lancet ; McCombs RP. Serial courses of corticotrophin or cortisone in chronic bronchial asthma. N Engl J Med ; Brown HM. Treatment of chronic asthma with prednisolone; significance of eosinophils in the sputum.
Lancet ; 2: Summing up years of asthma. Evolving concepts of asthma. The interaction between mother and fetus and the development of allergic asthma. Expert Rev Respir Med ; 8: Israel E, Reddel HK.
Severe and difficult-to-treat asthma in adults. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med ; Barnes PJ. Mechanisms of action of glucocorticoids in asthma. Effect of long-term treatment with an inhaled corticosteroid budesonide on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis ; Airway inflammation, basement membrane thickening and bronchial hyperresponsiveness in asthma. Thorax ; Respirology ; However some people have asthma that causes problems all the time, despite looking after themselves well and using their inhalers properly.
These people may need to use steroid tablets continuously every day or on alternate days to control their asthma. A respiratory specialist should first be seen to check that all other possible treatments have been explored, before someone engages on long term steroid treatment. When steroid tablets are taken in short bursts under about three weeks , there are usually no problems.
There can be increased appetite, mood change a high mood more often than a depressed one , and occasionally fluid retention and indigestion. Unwanted side effects happen the longer you take the steroid and the higher the dose used.
The main ones are:. Doses of Prednisone below 7mg a day are unlikely to give problems other than possible skin thinning. The higher the dose the more likely side effects are, so the doctor will be weighing up the risks of poor asthma control against the risk of steroid side effects and will keep the dose as low as possible.
The timing and frequency of taking the tablets can also influence side effects. Fewer side effects occur if:. Long-term steroid tablet treatment can weaken bones. So you will need to take extra doses of the steroid tablet instead. This can happen during illnesses. See your doctor straight away if you become ill. If you are vomiting or unable to swallow tablets, contact your doctor urgently. You must not be without steroid medicine, particularly if you are unwell.
For the same reason, it can be quite dangerous to stop long-term treatment suddenly — the body can find itself seriously short of steroid. Anyone taking regular steroid tablets should wear a Medic-Alert bracelet. Then, if an accident occurs, and extra steroid is needed, the doctors will know. When long-term treatment is to be stopped, this must be done very gradually.
The dose must be slowly reduced, often over several months. This allows the body time to start making its own cortisone again, Slow reduction will also stop unpleasant side effects, such as severe muscle aches, arthritis and depression.
Prednisone is used in severe episodes of asthma. It works slowly over several hours to reverse the swelling of the airways.
❾-50%}Appropriate use of oral corticosteroids for severe asthma | The Medical Journal of Australia.Corticosteroids - clinical applications: exacerbations of asthma in adults - Australian Prescriber
However, the vast majority of asthma exacerbations are mild. Many people are concerned about the adverse effects of corticosteroids, but these drugs are essential to reverse the eosinophilic inflammation which accompanies even mild exacerbations of asthma. An alternative is to give an inhaled corticosteroid because of its favourable adverse effect profile. Inhaled corticosteroid therapy is therefore an option for patients who present with a mild exacerbation of asthma.
Once asthma severity is assessed and the patient is defined as having a mild exacerbation, then the approach which I use is based upon a 'rule of twos'.
High dose inhaled corticosteroid beclomethasone or budesonide is administered twice daily, for two weeks, in a dose of 2 mg daily, or at least twice the maintenance dose whichever is the greater. Oral prednisolone is added if there is. Dose reduction The common practice of tapering the dose of oral corticosteroid after recovery from an exacerbation is complex for the patient and may be unnecessary. Several studies have compared abrupt cessation of corticosteroid after days' therapy with a tapering dose.
Tapering is not necessary provided that the patient is not using oral corticosteroids chronically, and is protected by high-dose inhaled corticosteroid after the oral steroid is stopped. It takes an average of days for symptoms and lung function to stabilise after an asthma exacerbation. Although biochemical evidence of partial hypothalamic-pituitary axis suppression can be detected after short courses of oral corticosteroid, this is rarely of clinical significance unless the patient has been taking steroids long term.
Tapering the dose is still indicated in the occasional patient who is chronically dependent upon oral corticosteroid as well as inhaled steroid for asthma control. In these circumstances, the dose is tapered at weekly intervals or longer until symptoms begin to recur.
This is done in order to identify the minimum maintenance dose of corticosteroid to maintain control of the asthma. When suppression of the hypothalamic -pituitary-adrenal axis has occurred from chronic corticosteroid usage, dose tapering should proceed very slowly over months with monitoring of plasma cortisol.
Controlled studies have not yet defined the best way to reduce the dose of inhaled steroids after exacerbations. One approach is to reduce the dose at weekly intervals in order to identify the minimum maintenance dose of inhaled steroid.
Inadequate response Inadequate response is not infrequent during exacerbations of asthma. These can be addressed by education and preparing an asthma action plan. As there is no specific therapy for mucus plugging in asthma, there may be a slow response to therapy when this is present.
The clinical relevance of individual variations of corticosteroid metabolism remains undefined. Influences on treatment There are a number of additional factors to consider when choosing therapy for patients.
Oral prednisolone is preferred if there is a history of severe asthma, life-threatening asthma, non-response to inhaled corticosteroids, or chronic use of high-dose inhaled corticosteroids or daily oral steroids.
In mild exacerbations, oral steroids are avoided if there is a history of adverse reactions, non-compliance, steroid phobia, or diabetes mellitus. In acute exacerbations of asthma, intravenous hydrocortisone is more effective than oral prednisolone. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition.
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This website uses cookies. Read our privacy policy. Skip to main content. Log in Log in All fields are required. Log in. Forgot password? Home Australian Prescriber Corticosteroids - clinical applications: exacerbations of asthma in adults A A. Gibson PG. Corticosteroids - clinical applications: exacerbations of asthma in adults.
Aust Prescr ; Article Authors. Subscribe to Australian Prescriber. Pathogenesis An exacerbation of asthma involves bronchospasm airway inflammation with cellular infiltration and oedema mucus plugging. Action plans instruct the patient when to increase treatment how to increase treatment for how long to take the increased treatment when to call the doctor. Which route of administration? Oral prednisolone is added if there is a recent history of a severe exacerbation a history of treatment failure with inhaled corticosteroid an unreliable inhalation technique no response after several days.
Self-test questions The following statements are either true or false. Corticosteroids have little effect on the mucus plugging which occurs in acute asthma Answers to self-test questions 1. False 2. Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis. Am J Emerg Med ; Engel T, Heinig JH. Glucocorticosteroid therapy in acute severe asthma - a critical review.
Eur Respir J ; Corticosteroids in acute severe asthma: effectiveness of low doses [see comments]. Thorax ; Comment in: Thorax ; Webb JR. Dose response of patients to oral corticosteroid treatment during exacerbations of asthma.
Br Med J ; Acute dose response studies in bronchial asthma with a new corticosteroid, budesonide. Br J Clin Pharmacol ; Timing of prednisone and alterations of airways inflammation in nocturnal asthma. Am Rev Respir Dis ; A research method to induce and examine a mild exacerbation of asthma by withdrawal of inhaled corticosteroid. Clin Exp Allergy ; Levy M, Stevenson IC. A comparison of the efficacy of inhaled fluticasone propionate 2 mg daily and a reducing course of oral prednisolone in the treatment of acute exacerbations of asthma.
Br Med J. In press. Double-blind trial of steroid tapering in acute asthma [see comments]. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted. Basic Search Advanced search search. Use the Advanced search for more specific terms. Title contains. Body contains.
Date range from. Date range to. Article type. Author's surname. First page. Issues by year. Article types. Research letters. Guidelines and statements. Narrative reviews. Ethics and law. Medical education.
Volume Issue 2 Suppl. Appropriate use of oral corticosteroids for severe asthma. Med J Aust ; 2 : SS Topics Respiratory tract diseases. Endocrine system diseases. Immune system diseases. Summary Severe asthma represents a significant burden of disease, particularly in high income nations; oral corticosteroids OCS remain an important part of the management toolkit for these patients.
History of oral corticosteroids use in asthma Before the s, the treatment for asthma was restricted to those compounds that were either plant-derived or adrenaline derivatives. Oral corticosteroids in the management of acute exacerbation of asthma The most well defined and frequent use of OCS in the management of severe asthma is during an asthma exacerbation.
Conclusion In summary, OCS continue to play an important role in the management of severe asthma. View this article on Wiley Online Library. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment.
Respir Med ; Eur Respir J ; Economic burden of asthma: a systematic review. BMC Pulm Med ; 9: After asthma: redefining airways diseases. Lancet ; McCombs RP. Serial courses of corticotrophin or cortisone in chronic bronchial asthma.
N Engl J Med ; Brown HM. Treatment of chronic asthma with prednisolone; significance of eosinophils in the sputum. Lancet ; 2: Summing up years of asthma. Evolving concepts of asthma. The interaction between mother and fetus and the development of allergic asthma. Expert Rev Respir Med ; 8: Israel E, Reddel HK. Severe and difficult-to-treat asthma in adults. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches.
Nat Med ; Barnes PJ. Mechanisms of action of glucocorticoids in asthma. Effect of long-term treatment with an inhaled corticosteroid budesonide on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics.
Am Rev Respir Dis ; Airway inflammation, basement membrane thickening and bronchial hyperresponsiveness in asthma. Thorax ; Respirology ; Woolcock AJ. Corticosteroid-resistant asthma. Hew M, Chung KF.
Corticosteroid insensitivity in severe asthma: significance, mechanisms and aetiology. Intern Med J ; Wenzel S. Severe asthma in adults. Distinguishing severe asthma phenotypes: role of age at onset and eosinophilic inflammation. J Allergy Clin Immunol ; Unsupervised phenotyping of Severe Asthma Research Program participants using expanded lung data. Haldar P, Pavord ID.
Noneosinophilic asthma: a distinct clinical and pathologic phenotype. J Allergy Clin Immunol ; ; quiz Does sputum eosinophilia predict the response to systemic corticosteroids in children with difficult asthma? Pediatr Pulmonol ; Global Initiative for Asthma. Global strategy for asthma management and prevention GINA; Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults.
Targeted therapeutics for severe refractory asthma: monoclonal antibodies. Expert Rev Clin Pharmacol ; 9: Upham J, Chung LP. Optimising treatment for severe asthma.
RIS file. Summary Cortico steroids are essential to reverse the eosinophilic airway inflammation which causes symptomatic exacerbations of asthma. Much of the current variation in clinical practice is not justified by data from clinical trials. Oral prednisolone is as effective as intravenous therapy and very high doses of corticosteroid are no better than modest doses mg prednisolone. Corticosteroids should be given twice a day for optimum effect. Therapy does not need to be tapered, but can be ceased abruptly after 10 days in most patients who are also taking high -dose inhaled corticosteroids.
There is an increasing role for inhaled corticosteroids in the management of mild exacerbations of asthma. The dose, route and duration of therapy need to be defined for each patient and written down as part of an action plan to enable early intervention in future exacerbations.
Introduction An exacerbation of asthma is a common and sometimes life -threatening complication which may require hospital admission. Although corticosteroids have been used for symptomatic exacerbations of asthma for many years, there is considerable variability in how they are used. There are probably as many corticosteroid regimens as there are physicians treating asthma. Clinical guidelines are attempting to standardise the approach to management, but they still have their problems.
Recognised triggers for asthma exacerbations include respiratory tract infections, allergens, occupational chemical exposure and non-specific triggers such as irritants and emotional factors. The aims of treatment are to prevent death, to relieve hypoxaemia, to normalise lung function as quickly as possible, and to prevent future relapses.
Corticosteroids are of proven benefit for eosinophilic airway inflammation, and bronchodilators are given to reverse bronchospasm. Specific therapy is not available for the poorly understood mucus plugging. Action plans In most cases the exacerbation progressively worsens over several days, or occurs on a background of chronic poor asthma control.
This provides an opportunity to intervene early in order to reduce the severity of the exacerbation. When a patient presents with acute asthma, this is an important occasion to review background asthma control, and to provide the patient with an asthma action plan. The main approach is the early use of sufficient corticosteroid and bronchodilator therapy to reverse the exacerbation. This approach needs to be defined individually for each person with asthma, and written down as an action plan.
Action plans instruct the patient. Failure to specify and adhere to each component of the action plan can result in treatment failure. Corticosteroids are particularly important in step 2, 'How to increase treatment'.
Are corticosteroids necessary? Corticosteroids are generally considered to be beneficial in exacerbations of asthma, although some studies have found minimal or no benefit. The clinical course of an asthma exacerbation varies from one patient to another. This may relate to the type of trigger, the presence or absence of corticosteroid responsive pathology eosinophilic bronchitis versus the degree of mucus plugging. There can be resolution with bronchodilators alone, a delayed response to corticosteroid, or treatment failure with no response to corticosteroid.
The literature therefore contains some trials showing that corticosteroids have no effect. The technique of meta-analysis has been used to deal with these variations in the published literature, so that the results of many clinical trials can be pooled to give a single measure of effect.
A meta -analysis of corticosteroid use in acute asthma shows that they are effective in reducing hospital admission rates, improving pulmonary function, and reducing relapses of asthma. The important issues are to define which corticosteroid, in what dose, how often, and by what route. Which corticosteroid to use? Many corticosteroids have been used to treat acute asthma. Overall, the drugs appear to be of similar efficacy when used at comparable doses.
The main differences in the drugs relate to their cost and adverse effect profile. Intravenous hydrocortisone is more expensive and has more associated mineralocorticoid properties than dexamethasone.
Oral drugs are cheaper than intravenous treatment, and prednisone or prednisolone is commonly used. In the absence of liver disease, there is no evidence that oral prednisone is less effective than prednisolone which does not require activation by hydroxylation in the liver.
Drug dosage A dose-response relationship for corticosteroids has been difficult to find in acute asthma. Of 12 controlled clinical trials which examined the dose-response of corticosteroids 23only two studies were able to show a difference between doses. In general, the literature does not support the use of high dose corticosteroids in acute asthma. Hydrocortisone 50 mg 4 times a day for 48 hours, followed by oral prednisone, was as effective as mg or mg of hydrocortisone followed by high dose prednisone.
Dose interval A single daily dose of corticosteroid may be inappropriate for exacerbations of asthma. There are several reasons for this. The duration of action of corticosteroid on lung function in unstable asthma peaks at 9 hours and falls after this Fig.
A convenient dose interval is therefore 12 hours. Effect of a single dose of ingested prednisolone 40 mg, inhaled budesonide 1 mg, and placebo on peak flow rate in adults with unstable asthma. Reprinted from Ellul-Micallef 5with permission. Oral or intravenous Although hydrocortisone is commonly injected for acute asthma, the routine use of this drug may be unnecessary.
Several randomised trials have compared oral to intravenous therapy for the treatment of acute asthma. These studies showed no difference in efficacy between the oral and intravenous route. The intravenous route is more costly, but is indicated when the oral route is unavailable.
A convenient regimen for moderately severe exacerbations of asthma is 50 mg prednisolone orally as an immediate dose, followed by 25 mg twice daily. However, the vast majority of asthma exacerbations are mild. Many people are concerned about the adverse effects of corticosteroids, but these drugs are essential to reverse the eosinophilic inflammation which accompanies even mild exacerbations of asthma. An alternative is to give an inhaled corticosteroid because of its favourable adverse effect profile.
Inhaled corticosteroid therapy is therefore an option for patients who present with a mild exacerbation of asthma. Once asthma severity is assessed and the patient is defined as having a mild exacerbation, then the approach which I use is based upon a 'rule of twos'. High dose inhaled corticosteroid beclomethasone or budesonide is administered twice daily, for two weeks, in a dose of 2 mg daily, or at least twice the maintenance dose whichever is the greater.
Oral prednisolone is added if there is. Dose reduction The common practice of tapering the dose of oral corticosteroid after recovery from an exacerbation is complex for the patient and may be unnecessary.
Several studies have compared abrupt cessation of corticosteroid after days' therapy with a tapering dose. Tapering is not necessary provided that the patient is not using oral corticosteroids chronically, and is protected by high-dose inhaled corticosteroid after the oral steroid is stopped.
It takes an average of days for symptoms and lung function to stabilise after an asthma exacerbation. Although biochemical evidence of partial hypothalamic-pituitary axis suppression can be detected after short courses of oral corticosteroid, this is rarely of clinical significance unless the patient has been taking steroids long term. Tapering the dose is still indicated in the occasional patient who is chronically dependent upon oral corticosteroid as well as inhaled steroid for asthma control.
In these circumstances, the dose is tapered at weekly intervals or longer until symptoms begin to recur. This is done in order to identify the minimum maintenance dose of corticosteroid to maintain control of the asthma. When suppression of the hypothalamic -pituitary-adrenal axis has occurred from chronic corticosteroid usage, dose tapering should proceed very slowly over months with monitoring of plasma cortisol.
Controlled studies have not yet defined the best way to reduce the dose of inhaled steroids after exacerbations. One approach is to reduce the dose at weekly intervals in order to identify the minimum maintenance dose of inhaled steroid.
Inadequate response Inadequate response is not infrequent during exacerbations of asthma. These can be addressed by education and preparing an asthma action plan. As there is no specific therapy for mucus plugging in asthma, there may be a slow response to therapy when this is present.
The clinical relevance of individual variations of corticosteroid metabolism remains undefined. Influences on treatment There are a number of additional factors to consider when choosing therapy for patients. Oral prednisolone is preferred if there is a history of severe asthma, life-threatening asthma, non-response to inhaled corticosteroids, or chronic use of high-dose inhaled corticosteroids or daily oral steroids.
In mild exacerbations, oral steroids are avoided if there is a history of adverse reactions, non-compliance, steroid phobia, or diabetes mellitus. In acute exacerbations of asthma, intravenous hydrocortisone is more effective than oral prednisolone. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition.
NPS MedicineWise disclaims all liability including for negligence for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer. This website uses cookies. Read our privacy policy. Skip to main content. Log in Log in All fields are required.
Log in. Forgot password? Home Australian Prescriber Corticosteroids - clinical applications: exacerbations of asthma in adults A A. Gibson PG. Corticosteroids - clinical applications: exacerbations of asthma in adults. Aust Prescr ; Article Authors. Subscribe to Australian Prescriber. Pathogenesis An exacerbation of asthma involves bronchospasm airway inflammation with cellular infiltration and oedema mucus plugging. Action plans instruct the patient when to increase treatment how to increase treatment for how long to take the increased treatment when to call the doctor.
The average length of prescription for corticosteroids such as prednisone is 5 to 10 days. In adults, a typical dosage rarely exceeds 80 mg. The more common. Hydrocortisone 50 mg 4 times a day for 48 hours, followed by oral prednisone, was as effective as mg or mg of hydrocortisone followed by high dose. Dose is based on prednisolone equivalency. Asthma, acute exacerbation Note: Prednisone is recommended for treatment of COVID in hospitalized. ANSWER A short course of steroids is indicated in the treatment of asthma exacerbations. Both prednisone (1 to 2 mg/kg daily for 5 days) and dexamethasone. Prednisolone is the most widely used steroid for maintenance therapy in people with chronic asthma. There is no evidence that other steroids offer an advantage. Narrative reviews. Severe asthma represents a significant burden of disease, particularly in high income nations; oral corticosteroids OCS remain an important part of the management toolkit for these patients. Med J Aust ; Respirol Case Rep ; 6: eYour doctor may use your peak flow record and symptom diary as a guide to reduce and stop the Prednisone tablets. A short course of Prednisone is safe with no lasting side effects. If you need Prednisone tablets more than twice a year, your asthma is not under control. Talk to your doctor about your options. You may need to review your Self Management Plan or visit a specialist. The tablet most commonly used is Prednisone, which comes in sizes of 1mg, 5mg, and 20mg. Others less often used are Betnesol 0.
The dose varies such a lot depending on the person — from mg to 40mg per day. The doctor will all the time be attempting to bring the dose down to the lowest possible in order to reduce the likelihood of side effects. Many people are accustomed to taking short courses a few days or weeks of steroid tablets for attacks of asthma.
However some people have asthma that causes problems all the time, despite looking after themselves well and using their inhalers properly.
These people may need to use steroid tablets continuously every day or on alternate days to control their asthma. A respiratory specialist should first be seen to check that all other possible treatments have been explored, before someone engages on long term steroid treatment. When steroid tablets are taken in short bursts under about three weeks , there are usually no problems.
There can be increased appetite, mood change a high mood more often than a depressed one , and occasionally fluid retention and indigestion. Unwanted side effects happen the longer you take the steroid and the higher the dose used. The main ones are:. Doses of Prednisone below 7mg a day are unlikely to give problems other than possible skin thinning. The higher the dose the more likely side effects are, so the doctor will be weighing up the risks of poor asthma control against the risk of steroid side effects and will keep the dose as low as possible.
The timing and frequency of taking the tablets can also influence side effects. Fewer side effects occur if:. Long-term steroid tablet treatment can weaken bones. So you will need to take extra doses of the steroid tablet instead. This can happen during illnesses. See your doctor straight away if you become ill. If you are vomiting or unable to swallow tablets, contact your doctor urgently.
You must not be without steroid medicine, particularly if you are unwell. For the same reason, it can be quite dangerous to stop long-term treatment suddenly — the body can find itself seriously short of steroid.
Anyone taking regular steroid tablets should wear a Medic-Alert bracelet. Then, if an accident occurs, and extra steroid is needed, the doctors will know. When long-term treatment is to be stopped, this must be done very gradually. The dose must be slowly reduced, often over several months. This allows the body time to start making its own cortisone again, Slow reduction will also stop unpleasant side effects, such as severe muscle aches, arthritis and depression. Prednisone is used in severe episodes of asthma.
It works slowly over several hours to reverse the swelling of the airways. If you stop too early your asthma may get worse again. The main ones are: Increased appetite and weight gain. Thinning of the bones, which can lead to bone fractures if very severe. Slowing of growth in children. Easy bruising of the skin and slow healing of cuts. Puffiness or roundness of the face. Indigestion or stomach ulcers. Fluid retention with swelling of the ankles. Cataracts in the eyes. You can help keep the dose down by: taking your other asthma medicines as usual; using your inhaler right — ask your nurse or doctor to check your technique, use a spacer with an MDI Metered Dose Inhaler or see if an alternative device could be of help; measuring your peak flow every day, and follow a Self Management Plan , starting extra treatment early; letting the doctor know if your peak flow reading drops or you feel unwell.
Fewer side effects occur if: the steroid tablets can be taken every other day, instead of each day even if a slightly bigger dose is needed to keep the asthma under control ; the daily dose is taken as a single dose in the morning. Morning is the time the body normally products its cortisone for the day; taken during or after meals. Bone strength Long-term steroid tablet treatment can weaken bones. Your doctor may be able to help you plan ahead for certain problems.
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