The past few days, I’ve been hacking my lungs up, and yesterday the doc confirmed what I suspected, bronchitis complicated by asthma (or asthma complicated by bronchitis, although I guess in the end there’s no difference). First he pumped my lungs full of albuterol with the nebulizer, then he prescribed a 4mg, 6-day pack of methylprednisolone, along with 10 days of amoxicllin (875 mg, 2x/day), along with the advice to take Robitussin before bed, use Vick’s Vapo-Rub and/or my albuterol inhaler if I need it, and in general to take a multivitamin and a calcium supplement (but I think he gives those last 2 bits of advice to everyone).
Well, the rest of it is OK, I guess, but I hate the idea of taking steroids, even if only for a few days (I did do it a year ago for a couple of weeks when I had a similar episode). My dad’s lungs are much worse than mine; he has taken them daily over many years, and is convinced he’s having side effects in terms of bone density, which led him to spend several months on crutches a couple of years ago. I’ve already had problems getting my leg bones to grow back together properly after a bad break a few years ago, to the point that I got wthin a few minutes of having bone graft surgery (long story), and osteoporosis runs on mom’s side of the family, so I’m pretty concerned about protecting my bones. That, and the label precautions about informing any medical people if you need any other kind of treatment, being more susceptible to other illnesses, avoiding vaccines and exposure to chickenpox, measles, or TB for a year after taking the stuff don’t exactly thrill me.
I’d be having this conversation with my regular doc, but know it’s a complex one, and he’s out of the country for the next couple of weeks (I saw one of his partners, who I’ve never seen before, but I was desperate). How can I sort out the medical literature on these issues? I’m not afraid of reading journal articles–God knows I did over the leg surgery thing–but could use some help sorting out what’s relevant in this situation. ANy suggestions for sources, especaillly online or otherwise easily available ones, are quite welcome.
Steroids are absolutely invaluable for the treatment of asthma. If inflammation has occurred and is narrowing the airways and triggering recurrent spasms, there is no better treatment than a burst of prednisone or similar medication to help clear it up quick!! Short term courses, from 3 to 10 days, are generally well-tolerated and have no long-lasting side-effects.
Inhaled steroids are also the gold standard for maintenance therapy for an asthmatic, to prevent recurrent inflammation and spasm. The inhaled variety has generally found to cause minimal side-effects in terms of bone thinning, growth suppression, etc.
Daily oral steroid use is generally reserved for those with severe asthma or emphysema, who would otherwise have next to no quality of life. Whenever possible, one tries to get the patient on every-other-day dosing, to minimize side effects. But there will be side-effects regardless. Here it is a relative risk assessment. Better to breath? Or to have strong bones? Most of my patients opt for breathing.
In short, I’d recommend you take the oral steroid burst for a short time, and talk to your doc about whether you need a steroid inhaler, to keep your asthma quieted down. Anyone who uses a rescue inhaler (like albuterol) more than once a week SHOULD be on some sort of maintenance medication. Inhaled steroids are preferred, but other agents (like leukotriene inhibitors or Tilade) can also be helpful.
Here you will find the NIH Asthma treatment guideline recommendations, and links to other journals. They are becoming the basis for standard of asthma care in this country. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
What Qadgop said.
Also, the more asthma exacerbations you have, the more you will have. Your airways become more reactive with each bout and so it becomes easier to occur again. One of the keys is to be aggressive early and the longer you go without an exacerbation the less reactive they become. Sort of a zen/stress thing (analogy-wise)- the more relaxed you are the easier it is to avoid stress, but the more stressed you are the easier it is to be stressed.
Also, also, the inflammation that occurs can leave permanent changes, so over the years your baseline (healthy) lung function can deteriorate if it’s not well controlled. So better to take a short course of the (low dose) steroids now than require more later.
-and definitely talk with your doctor when you can.
Well, generally I can go several weeks, or even months, without resorting to albuterol. (I hate it; it makes my hands shake and makes me completely loopy. I had to hang around the doctor’s office for the better part of an hour yesterday before they stopped shaking enough that I felt safe driving home.)
My primary triggers are cigarette smoke (not mine, I’ve never smoked, only secondhand!), allergies, and emotional stress…but every once in a while a stupid cold will turn into something more serious. So I don’t really think I’m a candidate for maintenance medication right now, short of keeping the allergies in check and not hanging out in smoky bars.
Every once in a while, though, there is a band playing in a bar that I just HAVE to see, and so I give in, and last a few hours before regretting it. Usually the ill effects are gone in a few hours, but I think this time they hung around, or maybe exacerbated something that was coming on anyway. The doc did yell at me for waiting the better part of a week before I came in, and for not using the albuterol more often when I sound as bad as I did yesterday. I feel much better now, though, and have never ended up in the E.R., and hope to keep it that way. The leg has been such a saga for almost the past 6 years, though…I’m fond of breathing, but I’m fond of walking, too.
In any case, thanks for the advice, and it looks like there’s a little light reading awaiting me!
It sounds like you’ve been prescribed a fairly low dose of steroids (my 10 year old, by contrast, is generally given 50mg of prednisone daily for 3 days when she develops an inflammation problem). The very short duration for which the steroids are prescribed is the key to getting the asthma under control while minimising any potential side effects from the steroids.
My daughter is also on preventative steroids, but the issues regarding use of those are somewhat different to the short term/high dose steroid regimens prescibed to bring an acute episode of inflammation under control.
Eva Luna. while long-term steroid use DOES cause problems, you’re not talking about long-term use. You’re talking about short-term use.
Here’s a slightly different example. Long term use of painkillers can be a Bad Thing. But would you refuse painkillers for the first few days to a week after major surgery because of that? I don’t think so.
When you have a flare up like that take the short course of steroids. It’s much better than trying to tough it out. I’ve tried it both ways and I’m now a firm believe in the (appropriate and judicious) use of short-course steroids for an asthma flare up.
Eva Lunas asthma sounds very much like mine (except for the smoke thing, I smoke my own and don’t have a problem with it). My doctor suggested (way back when) that I take the steroid every day, but having seen my grandmothers back “?” from lifelong cortizone use, I declined. My asthma is also triggered by colds and infections so what I do, is when I start feeling a cold coming on, I start in on the steroid inhaler, at the very least a puff night-time, sometimes morning and night. That usually prevents an attack and I don’t have to use “the blue one”…
The shakes I get are fairly wild too, the headspinning is kinda fun tho.
If you start a little before a cold breaks out, or perhaps the morning before you have to go to a nightclub, then you might be able to circumvent an attack altogether. Good luck!
Eva Luna, by your description, it sounds like you have Mild Intermittent asthma, or asthma requiring rescue medication less than once a week. In those circumstances, the recommendation is generally that no maintenance medication be given, but significant flare-ups be treated with a short course of anti-inflammatories like steroids.
If an asthmatic knows they have certain triggers (like cats or smoke) and knows that they will be exposed to those triggers, sometimes using medications like inhaled steroids or histamine blockers like Tilade or Intal for a few hours or days before the exposure could be considered.
