jjaksic
01-21-2003, 04:02 PM
When you have an asthma attack and go to the ER, you are given a high dose of a steroid to reverse the inflammation. Are you then given a perscription for more prednisone for a few more days to make sure it has been reversed?
And so this steroid reverses the inflammation and you're back to "normal" so to speak. Then some time later you might come in contact with another asthma trigger and hence another asthma attack?
What I'm asking is if you have your symptoms reversed and you do not come in contact with that "trigger" or "allergen", you will not have any more asthma attacks?
Are you lungs brought back to a comfortable state of normalcy? Or do you still hear wheezing and constriction when you've had your inflammation reversed?
I need this information before I see a pulmonologist.
And so this steroid reverses the inflammation and you're back to "normal" so to speak. Then some time later you might come in contact with another asthma trigger and hence another asthma attack?
What I'm asking is if you have your symptoms reversed and you do not come in contact with that "trigger" or "allergen", you will not have any more asthma attacks?
Are you lungs brought back to a comfortable state of normalcy? Or do you still hear wheezing and constriction when you've had your inflammation reversed?
I need this information before I see a pulmonologist.
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Blue4U2
01-21-2003, 05:30 PM
An interesting question.
But I had never really heard of prednisone being used to "reverse" asthma symptoms, but, to relieve them.
Prednisone is an anti-inflammatory.....and for the most part, many people with asthma often have several triggers.... I suppose it depends how sensative you are.
I have been on about 6 separate prednisone treatments,
and thought I had removed all triggers.... I was out of work for half a year.... it was so bad.
But it is always worth going to a pulmonologist when you develope any breathing problems, so that a mild problem doesn't become a terrible and major problem.
HAng in there ;)
Blue
But I had never really heard of prednisone being used to "reverse" asthma symptoms, but, to relieve them.
Prednisone is an anti-inflammatory.....and for the most part, many people with asthma often have several triggers.... I suppose it depends how sensative you are.
I have been on about 6 separate prednisone treatments,
and thought I had removed all triggers.... I was out of work for half a year.... it was so bad.
But it is always worth going to a pulmonologist when you develope any breathing problems, so that a mild problem doesn't become a terrible and major problem.
HAng in there ;)
Blue
wrin
01-22-2003, 10:57 AM
There are three hallmark signs of asthma.
Bronchoconstriction, increased secretions, and inflammation.
The prednisone takes care of the inflammation.
Prednisone is the big-guns of anti-inflammatories -- it also has the most side-effects. It is not to be used for maintenance unless you physically CAN NOT tolerate anything else.
Whether you come in contact with these triggers or not is partly irrelevant -- I say partly because as much as if you are exposed to them more, you will get sicker, if you are not ever exposed to them at all, the inflammation will still be present, albeit in a smaller amount.
It is practically impossible to never come in contact with your trigger or allergen again, especially when you consider like 99% of north americans have some severity of an allergy to dust mites. (Even if that allergy is miniscule.)
Wheezing and constriction can happen from the bronchospasm, or the muscles constricting when you have an acute attack. This can happen in the absence of large amounts of inflammation, but inflammation makes it worse, as your airway lumen size is further decreased by the inflammation. This is to say that no matter how small the amount of inflammation you have, it means that the airway hyperreactivity that is a hallmark of asthma will probably never go away, so you will never be totally safe from having another acute attack.
They are *technically* brought back to their comfortable state of normalcy, but you need to maintain some kind of maintenance steroid therapy (usually inhaled steroids will do the trick if you're not severely severely asthmatic) to keep the inflammation from coming back.
This is one of those an-ounce-of-prevention-is-worth-a-pound-of-cure things. 500mcg of Flovent inhaled will do a good job of preventing an asthma attack that'll take a week-long-course of 5mg prednisone to kill.
[This message has been edited by wrin (edited 01-22-2003).]
Bronchoconstriction, increased secretions, and inflammation.
The prednisone takes care of the inflammation.
Prednisone is the big-guns of anti-inflammatories -- it also has the most side-effects. It is not to be used for maintenance unless you physically CAN NOT tolerate anything else.
Whether you come in contact with these triggers or not is partly irrelevant -- I say partly because as much as if you are exposed to them more, you will get sicker, if you are not ever exposed to them at all, the inflammation will still be present, albeit in a smaller amount.
It is practically impossible to never come in contact with your trigger or allergen again, especially when you consider like 99% of north americans have some severity of an allergy to dust mites. (Even if that allergy is miniscule.)
Wheezing and constriction can happen from the bronchospasm, or the muscles constricting when you have an acute attack. This can happen in the absence of large amounts of inflammation, but inflammation makes it worse, as your airway lumen size is further decreased by the inflammation. This is to say that no matter how small the amount of inflammation you have, it means that the airway hyperreactivity that is a hallmark of asthma will probably never go away, so you will never be totally safe from having another acute attack.
They are *technically* brought back to their comfortable state of normalcy, but you need to maintain some kind of maintenance steroid therapy (usually inhaled steroids will do the trick if you're not severely severely asthmatic) to keep the inflammation from coming back.
This is one of those an-ounce-of-prevention-is-worth-a-pound-of-cure things. 500mcg of Flovent inhaled will do a good job of preventing an asthma attack that'll take a week-long-course of 5mg prednisone to kill.
[This message has been edited by wrin (edited 01-22-2003).]
charleyhorse
01-25-2003, 12:44 AM
What is so tricky about treating asthma is that inflamation can still be lurking even when we feel "just fine." I know I wish I had taken better care of the asthma when it was relatively mild. Now, I have to take prednisone on a maintenance basis - believe me, you do not want to go there if you can avoid it. I think if I had taken the inhaled steroids the way they were prescribed 20 years ago I might not be in this mess today.
Barb
Barb
wrin
01-25-2003, 04:56 PM
Biggest problem was 20 years ago they didn't have 20 years of proof that the inhaled steroids weren't just as bad as the prednisone -- or that they worked just as well.
Ahh, time does some good things to us.
Ahh, time does some good things to us.
roy66
02-01-2003, 08:29 PM
Have you ever heard of moving to a dryer climate to releive symptoms?I've been told to move to Arizona by one doctor and then another doctor told me the pollution makes it worse.
laci
02-01-2003, 10:40 PM
The thing with using inhaled steroids for inflammation is that you usually stay on it forever, right?
With oral prednisone (which has terrible side effects) you can take it for 5 days and get relief.
Right now my pulmonologist has me on a nasal steroid for the sinus inflammation and Advair for the lung
inflammation. I'll do it for 6 weeks then see him.
But even if it does help, which I hope it does, won't I have to stay on the Advair to keep my lungs in a "normal" state so to speak?
Can an inhaled steroid do the same job as prednisone? I guess that's a question for my pulmonologist. I guess he thinks so. Or else he just doesn't know what else to do for me.
With oral prednisone (which has terrible side effects) you can take it for 5 days and get relief.
Right now my pulmonologist has me on a nasal steroid for the sinus inflammation and Advair for the lung
inflammation. I'll do it for 6 weeks then see him.
But even if it does help, which I hope it does, won't I have to stay on the Advair to keep my lungs in a "normal" state so to speak?
Can an inhaled steroid do the same job as prednisone? I guess that's a question for my pulmonologist. I guess he thinks so. Or else he just doesn't know what else to do for me.
wrin
02-02-2003, 03:10 PM
Yes, Laci, that's true, BUT...
Consider the dosage. You take anywhere from 5-20 milligrams of prednisone for five days, and it causes how many systemic side-effects, blah blah blah.
The inflammation is going to be there for the rest of your life, and the more acute attacks you have where you need prednisone, the more damage you're doing to your body, and your lungs.
Prednisone has horrific long-term side-effects. Taking it more than you ABSOLUTELY NEED TO can cause incredibly horrible things to happen, including predisposition to long-bone fractures, and blood clots (which can precipitate anything from heart attacks to stroke to blindness.) Basically, it's some nasty stuff.
Yes you will have to stay on Advair to keep your lungs in a normal state -- but let's consider this. A pretty common dosage of advair is 250 micrograms twice a day. So we'll say 500 micrograms a day. Now we'll take the prednisone, at a common dose, maybe 5 mg a day. Five milligrams is five thousand micrograms. That's ten times a daily dose of advair -- and frankly, that's a small dose of prednisone.
The idea of an inhaled steroid is to do the same job as prednisone, yes. But you're taking the inhaled steroid in much smaller doses, so when it is absorbed systemically, it shouldn't cause as many side-effects. The idea is to keep side-effects down, and with inhaled steroids you're also supposed to titrate to effect. Which means you reduce the dose as low as possible to keep yourself from getting symptoms.
Flovent (which is the steroid in advair) is one of the best on the market -- it is absorbed the fastest out of any inhaled steroid so far, and works extremely well while being exceedingly safe.
Please don't fall into the notion that because you take prednisone for a week you're better. Think of taking the advair like preventing your inflammation from ever getting bad enough for you to need prednisone. Doesn't mean it won't happen, because our lungs do wonky things sometimes, quite frankly, but it's one of the best methods of control we have.
Consider the dosage. You take anywhere from 5-20 milligrams of prednisone for five days, and it causes how many systemic side-effects, blah blah blah.
The inflammation is going to be there for the rest of your life, and the more acute attacks you have where you need prednisone, the more damage you're doing to your body, and your lungs.
Prednisone has horrific long-term side-effects. Taking it more than you ABSOLUTELY NEED TO can cause incredibly horrible things to happen, including predisposition to long-bone fractures, and blood clots (which can precipitate anything from heart attacks to stroke to blindness.) Basically, it's some nasty stuff.
Yes you will have to stay on Advair to keep your lungs in a normal state -- but let's consider this. A pretty common dosage of advair is 250 micrograms twice a day. So we'll say 500 micrograms a day. Now we'll take the prednisone, at a common dose, maybe 5 mg a day. Five milligrams is five thousand micrograms. That's ten times a daily dose of advair -- and frankly, that's a small dose of prednisone.
The idea of an inhaled steroid is to do the same job as prednisone, yes. But you're taking the inhaled steroid in much smaller doses, so when it is absorbed systemically, it shouldn't cause as many side-effects. The idea is to keep side-effects down, and with inhaled steroids you're also supposed to titrate to effect. Which means you reduce the dose as low as possible to keep yourself from getting symptoms.
Flovent (which is the steroid in advair) is one of the best on the market -- it is absorbed the fastest out of any inhaled steroid so far, and works extremely well while being exceedingly safe.
Please don't fall into the notion that because you take prednisone for a week you're better. Think of taking the advair like preventing your inflammation from ever getting bad enough for you to need prednisone. Doesn't mean it won't happen, because our lungs do wonky things sometimes, quite frankly, but it's one of the best methods of control we have.
laci
02-02-2003, 03:17 PM
Okay. So why is he trying me a 6 week course using Advair and Rhinocort, if in fact, he thinks it won't help improve the inflammation?
Or will it help improve the inflammation?
Or will it help improve the inflammation?
charleyhorse
02-02-2003, 09:26 PM
That was really good explanation Wrin. Laci, the trial course is probably to see how well you react. It takes a few weeks for the inhaled steroid in the Advair to have its full effect. It has a long-acting brochodilator too (Serevent) which should give you some sympomatic relief. If all goes well, this may be all you need to keep your asthma under control with an occassional puff of a quick relief med like Ventolin if you get into a problem. And you may sometimes get a flair up that is bad enough to require a short burst of prednisone but, like Wrin said, that's the really big guns for serious, potentially dangerous episodes. Personally, I have to take anywhere from 5mg to 20 mg a day of prednisone, depending on the time of year. That's because I have a form of asthma that is oral steroid-dependent. That is not a common situation. Most people can get excellent control with an inhaled steroid - which is a very safe, very effective way of dealing with the underlying inflamation of asthma.
Barb
Barb
wrin
02-03-2003, 03:57 PM
Thanks barb :)
Barb's right -- he's giving it to you to see how you react. I can't take that particular corticosteroid -- it makes my voice hoarse, and for someone who prides themselves on their voice, that sure doesn't sit well with me, so I'm on a different medication regimen.
You have to make sure that you keep taking it though, the long-acting bronchodilator in Advair will make you feel better almost right away, so you might be tempted to not take it when you are feeling fine. But don't fall into this trap.
Inhaled steroids when taken regularly, work at their peak within about 2 weeks. So by the end of 2 weeks, you should be seeing some kind of improvement. In your case, twice a day, 12 hours apart would be the best regimen, so look at like, maybe first thing in the morning and right after dinner or right before bed. The right-before-bed since most of us have longer waking hours than sleeping hours doesn't work so well but if you have problems with nighttime symptoms it might be better for you. .. But this is not to say that your symptoms won't continue to improve beyond what you see after two weeks. They very well could.
Barb's right -- he's giving it to you to see how you react. I can't take that particular corticosteroid -- it makes my voice hoarse, and for someone who prides themselves on their voice, that sure doesn't sit well with me, so I'm on a different medication regimen.
You have to make sure that you keep taking it though, the long-acting bronchodilator in Advair will make you feel better almost right away, so you might be tempted to not take it when you are feeling fine. But don't fall into this trap.
Inhaled steroids when taken regularly, work at their peak within about 2 weeks. So by the end of 2 weeks, you should be seeing some kind of improvement. In your case, twice a day, 12 hours apart would be the best regimen, so look at like, maybe first thing in the morning and right after dinner or right before bed. The right-before-bed since most of us have longer waking hours than sleeping hours doesn't work so well but if you have problems with nighttime symptoms it might be better for you. .. But this is not to say that your symptoms won't continue to improve beyond what you see after two weeks. They very well could.
laci
02-04-2003, 12:30 AM
Thanks everyone for your patience in explaining it to me.
I'll let you know how I do six weeks from now!
I'll let you know how I do six weeks from now!