RADS and steroids

[pearly]

I was diagnosed with Reactive airway disease after 9-11.  (I live in downtown Brooklyn, also at the time worked about 18 blocks from WTC).  I'm female,  never had asthma symptoms before, and don't smoke.  I went to the ER in October and was diagnosed there, and the attending Dr. gave me a prescription for oral steroids (medrol 6-day pack, 4mg per tablet) as well as albuterol.  When I read the leaflet w/ medrol  i was very frightened about the side effects.  I had an appointment for the following day with a pulmonologist.  On the day of the appointment, I took half of the first day's dose (3 pills @ 4 mg each) and went to the pulmonologist.  she told me to throw the pills away, that they  were very dangerous, caused really bad side effects and would make me crazy.  she gave me qvar inhaler 80mcg instead.  I didn't want to take the pills so at the time i was happy she did this.

That night, the side effects from the 3 pills included crazy thoughts, severe irritability, dizziness, and pressure inside my body and head, so that i really thought i was going nuts.  It took 2 days for these feelings to go away from just 3 pills!

However, I have now been on the inhaler (2 puffs 2x day) since Nov. 1 and I don't feel a bit better.  My spirometry in late Nov showed PEFR: 59, FEF25-75 = 65, FEF 50 =75 and diffusion in the 66-73 range.

I would like to know what the general thought is in regards to effectiveness of inhaled steroids in first-time RADS vs. the oral steroids.  Do you have any suggestions for me?  Thanks.

[cajun54]

Sometimes doctors give oral steroids for a short term to open the airways. After the dose pak is completed then the inhaled steroids usually work.  Oral steroids have very serious side effects but so does not breathing well.  Short term steroid use with dose paks can really help. the acceptable cut off for diffusion and Pulmonary function test is 80. That is normal number that is generally acceptable.  As an asthmatic I have taken dose paks off and on for yrs.  While I hate the side effects while I take them, it does make it easier to breathe and it seems to make my inhalers work better.  Sometimes my doctor has advised me to use the inhaler more than 2 puffs at a time  ask your doc about this.

[pearly]

RN:

Also, could you tell me what lowered diffusion numbers might indicate?  My diffusion #s were in the 66-73 range.

Thanks

[National Jewish]

Inhaled steroids are always preferable to oral steroids when there is not an acute situation. If someone is actively having a problem, it may take too long for inhaled steroids to work, and therefore, oral steroids are indicated. In the more chronic situation, inhaled steroids are excellent. The dose can be increased with much less chance of side effects. The answer to your question really has to do with the perception of the physician at the time of the evaluation. There are many instances when oral steroids are used to help someone with acute symptoms and other times when the inhaled route is the preferable choice.