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QUESTION: I have bronchial asthma and my doctor put me on an antibiotic and a steroid pack 6,5,4,3,2,1. When that was finished I still had breathing problems so said sometime you might need more steroids so he put me on Prednisone 20mg I tab 2x a day. Am I ok with this much steroids? I just don't want my lungs to get use to the steroids. I am on a inhaler for my asthma but this is the first time in about 30 years that I got bronchitis with it. I just want to make sust my lungs, which already have COPD are not going to be damaged by more steroids. I actually feel pretty good today and haven't started the second dose of Prednisone.

ANSWER: Hi Virginia,
I apologize for the delay, never reached my accounts. I received notice from all experts stating there were messages waiting. Anyway…
Is your physician an allergist or pulmonologist? If not, you really need to see one.
What is the inhaler medication you take every day for your lungs? I need to know that to better evaluate the present situation.
Also, are you on any other prescription drugs? Do you still smoke?
Does anyone in your home smoke?

Once I hear back from you, I'll be in a better position comment further.



---------- FOLLOW-UP ----------

QUESTION: My physician is my reg. doctor but he is in contact with my pulmonologist. My Pulmonologist took me off my Advair as he said I did not need it and put me on Pro-Air "as needed". My family doctor gave me Ventolin to take as he said it was the name brand and would work better. The other perscriptions I take are synthroid 50mg, Topiramate 50mg for migraines, Lunesta and my normal vitamins and minerals.

I do not smoke, I quit a year ago when they said I had the start of COPD, my husband smokes bu not in the house or around me.

I have not had bronchitis in over 20 years or anything like this in as long. Everyone around here seemed to have gotten the same thing. It just seemed like a lot of Prednisone and now to just stop 20mg cold turkey seems odd. should I cut them in half?

Hi Virginia, sorry again for the delay (my company was just bought out, and work has been crazy in the transition!).

When steroids are taken for 14 days or less, there is no need to taper. It's important to get the inflammation under control. Longer therapy does require tapering, because at that point, your normal production of steroids in your body are suppressed, and need to allow time for them to rebound to normal.

Regarding Ventolin vs Pro-Air, your physician is incorrect. Aside from minor variations in the vehicle, Ventolin-HFA, Pro-Air HFA and Proventil-HFA are ALL brand products of albuterol, and not generics. Furthermore, both Ventolin and Pro-Air both now have dose counters built in to keep track of usage. Should there be an issue with the degree of relief, the first issue to address is to insure the device is being properly used in administering the med. Has an asthma educator ever reviewed technique at any point since starting the med? Has your doctor asked that you bring your device to the office to verify technique? Up to 75% of patients do not use their devices correctly, and have not been properly instructed. A local doctor here claimed her Advair never helped her. I brought out a demo unit, and discovered she was using it incorrectly. Now consider all her patients therefore using it wrong.

If you are not getting complete relief, the preferred fast acting product to use then is Combivent, a combination of two meds to open the lungs.

If you would like, I can direct you to a demo for proper use of your inhalation units. Just let me know.

My work week will end next Monday morning (I work overnight shift). Any requests at this point will probably come at that point, but possibly sooner.





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Marc Rubin, RPh Asthma Educator


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.


Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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