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Asthma/prednisone pulse

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Expert: - 2/12/2008


Question
I had a bad case of the flu, then bronchitis. I was given Zithromax antibiotics
but continued to have shortness of breath. The doctor told me to take 30mg
prednisone for 2 days, then 2 days of 20, 2 days of 10 and then stop.
However, on the 4th day (today) I am having a horrible time breathing. If this
is prednisone pulse, shouldn't I have started off with much higher doses? I
have had to do this before and started with 80 mg - but that was a different
doctor. I am also taking inhaled cortisone (symbicort) and have my inhaler.
But should I take higher doses of cortisone until I can breathe again? Thanks
for your help.

Answer
The guidelines suggest that you stay on a fixed dose (up to ~60mg based upon 1mg/kg body weight, 1kg = 2.2 pounds)daily until your peak flow returns to 80 % of either predicted or personal best. Typically, that runs from 3 to 10 days, although some require the maximum of 14 days of oral steroid. Reducing the dose while you are still infected with a virus is cutting the treatment while the source of inflammation is still present. On a symptom based scale..yes when you can breath without coughing, chest tightness or wheezing.
Is the physician a board certified allergist/immunologist? IF not, that is who should be guiding your treatment, since they should be up on the latest medical approaches.
Hope this helps guide you.

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Marc Rubin, RPh Asthma Educator

Expertise

I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.

Experience

Practicing pharmacist for 34 years, specializing in asthma for past 7 years. Statewide education to nurses, teachers and athletic coaches regarding asthma. In addition, and closer to home. my wife and daughter both have asthma, and my son has exercise induced bronchospasm. I'm also on the advisory board of a medical education company, Emmi Solutions, and directly involved in the creation of public education programs for asthma, COPD and diabetes.

Organizations
American Academy of Allergy, Asthma and Immunology (AAAAI) / Sports Medicine Committee, American Thoracic Society (ATS). Chicago Asthma Consortium / Professional Development Committee, Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

Publications
AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm)

Education/Credentials
BScPharm, RPh, AE-C (NAECB Certified asthma educator), NIPCO Certified Respiratory Care Pharmacist

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