Prednisone for Asthma Exacerbations – What You Need to Know?

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Hi There, my name is Dr. Chet Tharpe, and I’m a board-certified allergy and asthma specialist in South Carolina. This morning I was on the asthma support group and there was a really good discussion about prednisone use and specifically the concerns about prednisone use during an asthma attack. So, I’d like to address prednisone use in asthma from the physician’s perspective and discuss side effects along with why and how it is used.

Asthma is an inflammatory condition of the lungs. And I like to describe asthma as basically a smoldering fire. And then when you get around your triggers such as extremes in temp, allergies, infections, etc your asthma, if poorly controlled has the potential to get out of hand. Those triggers are like pouring lighter fluid on that fire and an asthma attack ensues.

As a result, your airways swell, they become very tight and can spasm or constrict and they produce mucus. And this limits airflow out of your lungs, which will also limit airflow into your lungs. This can cause a variety of symptoms including chest tightness, shortness of breath, wheezing, cough. And the end result of this out of control fire and severe airflow limitation is what we call an asthma attack.

Since asthma has the potential to be deadly and it’s estimated that asthma contributes to over 10,000 deaths in the U.S. per year, not to mention 2 million ER visits and 500,000 hospitalizations per year, we as physicians like to get aggressive and put this fire out as rapidly as possible. No physician wants to take a chance on one patient having a bad outcome which in the vast majority of asthma cases, is avoidable.

As a result, prednisone or other similar steroids are often given to get you out of an asthma attack. Prednisone, which is taken in pill form by mouth is like a huge fire extinguisher. It acts fast and in most cases, if dosed correctly, should get the fire calmed down in a few hours and under control in a few days. It’s also like hitting the reset button on the inflammation in your chest. You should start feeling better pretty quickly.

Prednisone is often dosed at 40-60mg daily for adults and 1-2mg/kg for kids over a period of 5-7 days although 5 days bursts are the probably the most common way it’s prescribed for asthma exacerbations. For more severe asthmatics, longer courses of 10 or 14 days or in rare instances even longer may be needed.

Now, it’s also common to experience side effects from prednisone but these side effects should absolutely be outweighed by the benefits of controlling your asthma attack and preventing an ER visit, hospitalization or even death.

Common side effects that you may experience from a 5 or 7 day course of prednisone during an asthma attack include feeling anxious or moody, it can give you a stomach ache or heartburn-like symptoms. It can cause insomnia. It can also increase your appetite. As a result, I have my patients take it in a single dose for the day, ideally in the morning. Now, if you are a diabetic or have issues with elevated blood sugar, you should also be aware that steroids will increase your blood sugar. In most instances I just ask my patients to watch their blood sugars more closely than normal, increase their fluid intake and in some cases adjust their diabetic medication doses temporarily.

Some doctors may like to give you prednisone to have on hand to use it when you need it. I don’t like to do that. I may not require you to physically come and see me in my office to prescribe prednisone but I want to be able to keep tabs on your situation in real-time to assist in any way I can as well as ensure I know how often you are having asthma attacks requiring prednisone.

Asthma guidelines state that if you need steroids such as prednisone more than one time in a year, your asthma is not controlled and you’re at risk of a bad outcome from asthma. In other words, that smoldering fire in your chest, which is your asthma, should not get out of hand more than once a year when you are around your potential triggers. And unless you live in a bubble, being around allergens, extremes of temperature, infections and other possible triggers is inevitable.

If you are needing oral steroids like prednisone more than once per year, your physician needs to be aware so that you can discuss adjusting your controller medications or starting new ones such as steroid inhalers to prevent the asthma attack from occurring in the first place. Another way of putting this is, it is much safer for you to be on a daily asthma medication such as an inhaled steroid than it is to be on more than 1 course of oral steroids in 1 year. This not only prevents the bad outcomes associated with an asthma attack that we have discussed but also prevents your body from being exposed to repetitive courses of oral steroids which could have more serious side effects including increased risk for bone fractures, eye disease, cardiovascular disease among many others. Prednisone and other oral steroids can be extremely harmful if used regularly even in short bursts.

Another common question I often encounter involves the need to taper or decrease the dose of prednisone gradually before stopping it. You may have had prescriptions from some doctors who do not taper prednisone such as the classic 40mg daily x 5 days then stop regimen while others give you a tapering dose of prednisone or a similar steroid medication like Medrol in a Dose pack with a classic taper over 6 days.

In general, steroids like prednisone do not need to be tapered if given for less than 2 weeks. If you are on prednisone for longer than 2 weeks, the concern is that your adrenal glands, tiny glands that sit over your kidneys that produce your body’s natural steroid hormones, will shut down since they receive signals from your body that enough steroids are already available and no more is needed. As a result, those adrenal glands will basically kind of shut down temporarily.

Thus, if prednisone is given for courses greater than 2 weeks, tapering or lowering the dose of prednisone gradually, provides signals to your adrenal glands that they need to wake up and get back to work since your body is no longer getting sufficient steroids from medication.

Steroids perform a lot of bodily functions such as regulating blood pressure and other hormonal responses in our body. If you’ve been on a long course of high dose steroids for greater than 2 weeks and you abruptly stop without tapering them you will likely feel horrible and sluggish with a terrible headache until your adrenal glands can kick back in and produce sufficient quantities of steroids. However, in rare instances, if you were to get an infection and your body was unable to produce enough steroid hormones in response to the infection, you can go into what’s called an adrenal crisis resulting in extremely low blood pressure or shock that has the potential to be deadly.

Otherwise, a 5, 7 or even up to a 14 day course will typically not shut your adrenal glands down so stopping steroids without tapering before 14 days is quite alright in most instances.

Don’t forget however that every medical provider and patient case is different, so there are not any hard and fast rules surrounding steroid tapering and prescribing. Try to make a note of what steroid prescription works best for you as far as treatment effectiveness, minimal side effects, etc along with what hasn’t and provide that feedback to your doctor. They will appreciate the input and the knowledge of what has worked for you in the past and what hasn’t.

So, to recap, steroids such as prednisone are essential in the event of an asthma attack to prevent ER visits, hospitalizations and even death. However, you need to be aware of how often you are needing steroid courses for asthma attacks. This should give you a good indication of how well controlled or poorly controlled your asthma is and you should also keep in mind that frequent courses of oral steroids are just plain harmful to your body.

So, as always, I hope this has helped you in your respective situation and also hope it will stimulate a productive discussion with your physician. If you liked this video, please leave me a comment and subscribe to my e-mail list where I can keep you updated on new videos and educational opportunities through ChetTharpeMD.com. Thanks for your support! Great days are ahead!

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