Prednisone

Prednisone is used in severe episodes of asthma.

It works slowly over several hours to reverse the swelling of the airways.

Prednisone needs to be continued for several days after your asthma symptoms settle to make sure that the swelling doesn’t return.

Your doctor may use your peak flow record and symptom diary as a guide to reduce and stop the Prednisone tablets.

If you stop too early your asthma may get worse again.

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 (0.5mg soluble tablet), Cortisone (5 & 25mg), Dexamethasone (1 & 4mg), Medrol (4mg), and Prednisolone (very similar to Prednisone).

The dose varies such a lot depending on the person – from 2-3mg 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:

• Increased appetite and weight gain.
• Thinning of the bones, which can lead to bone fractures if very severe.
• Slowing of growth in children.

The body’s own natural production of the steroid cortisol is reduced; this can be a problem when steroid tablets are stopped or when the body needs a surge of more steroid to cope with an acute illness.

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.

Doses of Prednisone below 7mg a day are unlikely to give problems other than possible skin thinning. 10mg/day or more will most likely give some of these effects after a few years. 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.

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.

The timing and frequency of taking the tablets can also influence side effects. 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. This can’t be prevented altogether, but can be reduced if:

• you stay as fit and active as possible;
• There are now some other medications that can keep the bones stronger; your doctor can discuss this with you or refer you to a specialist in the bone field. a special sort of x-ray may be needed to measure the density of the bone (it is quite easy and doesn’t hurt) before deciding on the best treatment to use and even whether treatment is needed at all.

Extra steroid doses

Because the body’s own natural steroid production is switched off when you take steroid tablets for a long time, it may not be able to respond quickly enough if suddenly your body needs an extra boost of steroid. So you will need to take extra doses of the steroid tablet instead. This can happen during illnesses.

If you are taking long-term steroid treatment you may need extra steroid during illnesses such as bad ‘flu, operations, asthma attacks and dental work or during any important health problem. See your doctor straight away if you become ill.

Your doctor may be able to help you plan ahead for certain problems.

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.

STOPPING LONG-TERM STEROID TREATMENT

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.

Slow reduction of steroid treatment must be done by your doctor, and the asthma carefully watched so it doesn’t worsen.