duration of oral prednisolone use in asthma

[ykw]

what is the normal duration of treatment for asthma using oral prednisolone? when to tapper? tq.

[Steve G]

30mg daily for a week is a pretty standard dose. This is what the BNF says about tapering of steroid doses:

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The CSM has recommended that gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have

* recently received repeated courses (particularly if taken for longer than 3 weeks)
* taken a short course within 1 year of stopping long-term therapy
* other possible causes of adrenal suppression
* received more than 40 mg daily prednisolone (or equivalent)
* been given repeat doses in the evening
* received more than 3 weeks’ treatment

Systemic corticosteroids may be stopped abruptly in those whose disease is unlikely to relapse and who have received treatment for 3 weeks or less and who are not included in the patient groups described above.

During corticosteroid withdrawal the dose may be reduced rapidly down to physiological doses (equivalent to prednisolone 7.5 mg daily) and then reduced more slowly. Assessment of the disease may be needed during withdrawal to ensure that relapse does not occur.

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So most patients receiving prednisolone for an exacerbation of asthma are not going to need to have their dose gradually reduced.

[ykw]

thanks for the reply. cos i saw a doctor prescribing prednisolone 50 mg od x 4/52 for a patient. so, i just wonder if this is appropriate. is dose-tappering needed if the patient is on steroid inhaler? tq.

[Steve G]

Seems a bit of a high dose, and for a long period. Is it definitely for asthma? Dose tapering is not normally needed if the patient is on inhaled steroids, as inhaled steroids aren't normally absorbed enough to supress cortisol secretion. However high doses of Flixotide, for example (i.e 2mg/day), may affect endogenous cortisol secretion.

[Pharmanaut]

Originally Posted by Steve G

Seems a bit of a high dose, and for a long period. Is it definitely for asthma? Dose tapering is not normally needed if the patient is on inhaled steroids, as inhaled steroids aren't normally absorbed enough to supress cortisol secretion. However high doses of Flixotide, for example (i.e 2mg/day), may affect endogenous cortisol secretion.

Better to have a chat to the patient to get further information and then make a phone call to make sure the dose/duration it is intentional.
High dose treatment of corticosteriods has been used for other diseases, but it generally causes more problems that it cures.
As Steve has commented it looks to high and too long for Asthma.

If the treatment is for a long period of time the patient will be well on their way to developing cushings syndrome. Their immune system will be suppressed so they could pick up infections easily, anything going around the community, such as chickenpox, and they would experience delayed wound healing. Make sure that they don't get into the repeat prescription cycle or the long term effects would not be pleasant.

[ykw]

thanks for replying.

[kemzero]

Has anyone read about an on going case against one of the big multi-nationals , an American patient is suing both her doctor and the chemist (here in England ) for braech in the duty of care . The pharmacist dispensed the steroid according to the GPs instructions but failed to make any appropriate interventions ( the patient got a very high dose hence is now battling with cushings syndrome) she is suing for £2m at the high court
.. don't know what to say ..all I can say is that as pharmacists we are not just pill counting professionals we need to be mega careful.. I have no doubt that you guys are anyway

[Linnear]

Originally Posted by kemzero

The pharmacist dispensed the steroid according to the GPs instructions but failed to make any appropriate interventions ( the patient got a very high dose hence is now battling with cushings syndrome)

As far as I could see the pharmacist had no reason to intervene. The dose was not excessive. The problem occurred in the US when the Dr prescribed the dose from the UK dispensing label!

she is suing for £2m at the high court
.. don't know what to say ..all I can say is that as pharmacists we are not just pill counting professionals we need to be mega careful.. I have no doubt that you guys are anyway

She's American and her business went t*ts up and she needed someone to blame!

[Zoggite]

Originally Posted by Linnear

As far as I could see the pharmacist had no reason to intervene. The dose was not excessive. The problem occurred in the US when the Dr prescribed the dose from the UK dispensing label!

...and from what I understand, the US doctor didn't just blindly repeat the Rx once, but repeatedly over a number of months, which is what really caused the Cushing effect...

[Jeff]

Originally Posted by Zoggite

...and from what I understand, the US doctor didn't just blindly repeat the Rx once, but repeatedly over a number of months, which is what really caused the Cushing effect...

The original fault lay with the UK doctor who was dumb enough to take on an american lawyer as a temporary patient.

Jeff