Steroid Use for Severe Asthma

[Cints]

I've been on 3-10 mg of steroids (prednisone is how it is called here) for the last five months because I continue to have mild to severe attacks that need me to have a portable oxygen tank a nebulizer and of course my broncodilator inhaler wherever I go.

This dosage has worked well for me, varying it depending on my symptoms. I take more when I have bad attacks (maximum of 10 mg/day) and less when I just have wheezing (minimum of 3 mg/day) There are no side effects for me except having difficulty sleeping sometimes. I take 3mg of melatonin to address that.

My question is, how long can I be taking this dosage? Indefinitely till I have just have some wheezing and mild attacks?

Before my hospitalization I only needed inhaled steroids (Flixotide) at 250 mcg 2x a day for maintenance but I can't seem to go back to that condition.

I know that prolonged steroids use is bad for my bones that may already be fragile (although my bone density test results are fine) because I had thyroid removed due to papillary carcinoma and now take sintroid for life.

Thank you.

[hayang]

this happened to my brother. he was on Flovent for a couple years then it stopped working and he was in and out of the ER with asthma attacks and on and off prednisone, 60 mgs for weeks at a time.
the best way the dr could describe what happened was by explaining that he developed a tolerance to his Flovent and he was switched to a different inhaled preventative inhaler. He was on Asmanex or a couple years and is now on Advair. He's been on Advair for three years and it seems to be doing the trick.
My brother is 21 and has had asthma all his life. I'm 19 and also have had asthma my entire life.  

[caregiver222]

Oral steroids are sometimes necessary, and one accepts the risks with the benefits. In the past they were over-prescribed and over-used, but when the lungs become really "twitchy", a short period of use may be the only way to calm things down. The pendulum swings, and from being over-prescribed in years past some physicians won't prescribe them at all.

[Cints]

Thank you again for your responses. Will see my endocrinologist soon to also clarify how long I can use oral steroids at least until my condition stabilizes.

[caregiver222]

I don't have the animal study handy, however the dosage was high. The steroids shut down the immune system. The adrenal issue is well-documented. If you need the steroids to stay alive you have no choice, however more frequent administration of aerosolized steroids might be considered.

[Cints]

Thank you for the information. Unfortunately the combination inhalers of steroids and broncodilators actually increase the symptoms for me.

Re the studies you mentioned, would you know how much prednisone was being taken daily by the lab animals in equivalent human terms? I realize that I can't remain on large or even medium dosages (delivered intravenously when I have had to be confined) for long periods or indefinitely; and that they have to be tapered off to prevent damaging my adrenals that may no longer be able to produce cortisol on its own.

But what about if the inhaled steroids can no longer mitigate the inflammation? Do I have to chose between the two evils, so to speak?

Thanks again.

[caregiver222]

Extended use or oral prednisone is not currently considered good medical practice in the United States. Studies suggest that one hundred percent of lab animals developed malignancies after six months of daily systemic prednisone. On the other hand aerosolized prednisone, which deposits a relatively tiny quantity on the lungs, had an excellent record of safety. The oral doseage may "work well", but there are significant side effects. You should consider a long-acting beta agonist such as Formetrol. I note that you have not mentioned such a medication.