Oral corticosteroids pharmacology

An example of an acute hepatitis-like syndrome arising after pulse methylprednisolone therapy.  These episodes arise typically 2 to 4 weeks after a third or fourth cycle of pulse therapy, and range in severity from an asymptomatic and transient rise in serum aminotransferase levels to an acute hepatitis and even fulminant hepatic failure.  In this instance, the marked and persistent rise in serum enzymes coupled with liver histology suggesting chronic hepatitis led to a diagnosis of new-onset autoimmune hepatitis, despite the absence of serum autoantibodies or hypergammaglobulinemia.  Autoimmune hepatitis may initially present in this fashion, without the typical pattern of serum autoantibodies during the early, anicteric phase.  The diagnosis was further supported by the prompt improvements in serum enzymes with prednisone therapy.  The acute hepatitis-like syndrome that can occur after pulses of methylprednisolone is best explained as a triggering of an underlying chronic autoimmune hepatitis caused by the sudden and profound immunosuppression followed by rapid withdrawal.  This syndrome can be severe, and fatal instances have been reported.  Whether reinitiation of corticosteroid therapy with gradual tapering and withdrawal is effective in ameliorating the course of illness is unclear, but anecdotal reports such as this one suggest that they are beneficial and should be initiated promptly on appearance of this syndrome.  Long term follow up of such cases is also necessary to document that the autoimmune hepatitis does not relapse once corticosteroids are withdrawn again.

In a 6-month pragmatic randomised prospective multicentre study, 95 adults with prednisone-dependent asthma from six pulmonary outpatient clinics were allocated to two tapering strategies: according to conventional treatment (n=43) or guided by a novel internet-based monitoring system (internet strategy) (n=52). Primary outcomes were cumulative sparing of prednisone, asthma control and asthma-related quality of life. Secondary outcomes were forced expiratory volume in 1 s (FEV1), exacerbations, hospitalisations and patient's satisfaction with the tapering strategy.

  • Prevent asthma symptoms from occurring
  • Can reduce and/or prevent:
    • Inflammation and scarring in the airways
    • Tightening of the muscle bands around the airways (bronchospasm)
  • Do not show immediate results, but work slowly over time
  • Should be taken daily, even when you are not having symptoms
  • Should NOT be used to relieve immediate asthma symptoms.

Back to top A Note about Long-Term Controller Medicines in Children According to the National Asthma Education and Prevention Program at the National Institutes of Health, long-term controller medicines should be considered when infants or young children have had three or more episodes of wheezing in the previous 12 months and who are at an increased risk of developing asthma because of their own or their parents' history of allergic diseases.

They also recommend long-term controller medicines for children who need short-acting bronchodilators (rescue medicines) more than twice a week or have had severe asthma symptoms less than six weeks apart. Without a controller medicine, the underlying inflammation will continue to cause more asthma symptoms.

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Long-acting corticosteroids improve lung function by suppressing inflammation in the respiratory passages and help reduce the need for oral medication. Types of long-acting corticosteroids and their usual daily dosages pinclude the following:

  • Aerospan (flunisolide HFA)—2 inhalations 2x/day
  • Alvesco (ciclesonide)—1-2 inhalations 2x/day
  • Asmanex Twisthaler (mometasone)—1 inhalation 2x/day or 2 inhalations 1x/day
  • Flovent HFA (fluticasone)—1-4 inhalations 2x/day
  • Pulmicort Flexhaler (budesonide)—1-2 inhalations 2x/day
  • QVAR (beclomethasone)—1-4 inhalations 2x/day

Oral corticosteroids pharmacology

oral corticosteroids pharmacology

Long-acting corticosteroids improve lung function by suppressing inflammation in the respiratory passages and help reduce the need for oral medication. Types of long-acting corticosteroids and their usual daily dosages pinclude the following:

  • Aerospan (flunisolide HFA)—2 inhalations 2x/day
  • Alvesco (ciclesonide)—1-2 inhalations 2x/day
  • Asmanex Twisthaler (mometasone)—1 inhalation 2x/day or 2 inhalations 1x/day
  • Flovent HFA (fluticasone)—1-4 inhalations 2x/day
  • Pulmicort Flexhaler (budesonide)—1-2 inhalations 2x/day
  • QVAR (beclomethasone)—1-4 inhalations 2x/day

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