Systemic corticosteroid therapy

Although the optimal duration of systemic corticosteroids is unknown, therapy should be continued until PEF is greater than or equal to 80% of predicted or personal best. According to the NAEPP, the usual regimen is to continue frequent multiple doses until the patient s FEVi or PEF improves to 50% of predicted and then decrease the frequency to twice daily. In general, the duration of therapy ranges from 3 days for mild exacerbations to 14 days for severe exacerbations. It is not necessary to taper the systemic steroid dose in patients receiving short bursts of systemic corticosteroid therapy, as the adrenal suppression that occurs is transient and rapidly reversible.18... 

Reassess pulmonary function every 20 to 30 minutes. If there was not an immediate response to the inhaled short acting p2-agonist, initiate systemic corticosteroid therapy. If the patient is not improving, add ipratropium to the patient s therapy and continue with a high-dose inhaled short-acting P2-agonist. 

Treatment of active mild to moderate Crohn s disease involves use of oral or topical aminosalicylate derivatives, whereas moderate to severe disease may require systemic corticosteroid therapy. 

Evaluate patients receiving systemic corticosteroid therapy for improvement in symptoms and opportunities to taper or discontinue steroid therapy. For patients using more than 5 mg daily of prednisone for more than 2 months or for steroid-dependent patients consider the following ... 

Systemic corticosteroid therapy is not recommended in OA, given the lack of proven benefit and the well-known adverse effects with long-term use. 

The clinical benefits of systemic corticosteroid therapy in the chronic management of COPD are often not evident, and there is a high risk of toxicity. Consequently, chronic, systemic corticosteroids should be avoided if possible. 

Concomitant systemic corticosteroid therapy- See Administration in group monograph. 

Do not use fluticasone propionate/salmeterol for transferring patients from systemic corticosteroid therapy. ... 

Urgent treatment is often begun with an oral dose of 30-60 mg prednisone per day or an intravenous dose of 1 mg/kg methylprednisolone every 6 hours the daily dose is decreased after airway obstruction has improved. In most patients, systemic corticosteroid therapy can be discontinued in a week or 10 days, but in other patients symptoms may worsen as the dose is decreased to lower levels. Because adrenal suppression by corticosteroids is related to dose and because secretion of endogenous corticosteroids has a diurnal variation, it is customary to administer corticosteroids early in the morning after endogenous ACTH secretion has peaked. For prevention of nocturnal asthma, however, oral or inhaled corticosteroids are most effective when given in the late afternoon. 

Gass JD, Little H. Bilateral bullous exudative retinal detachment complicating idiopathic central serous chorioretinopathy during systemic corticosteroid therapy. Ophthalmology 1995 102(5) 737 I7. 

Although at least five other pharmaceutical companies claimed priority of the invention (Merck, Squibb, Pfizer, Upjohn and Syntex), none was able to convince the U.S. Patent Office. A patent was finally issued to Schering Corp. in 1964 (10 years after the initial filing). To this day, prednisone and prednisolone remain the standard of systemic corticosteroid therapy throughout the world. 

Mr GM took NSAIDs to alleviate the pain and irritation associated with his psoriasis. NSAIDs, such as ibuprofen and indometacin, have been shown to exacerbate psoriasis. Mr GM should be appropriately counselled in his use of pain medication. Further, the patient has failed to give treatment enough time to work in the past, citing associated pain and irritation of his condition. This may be due to the patient s use of ibuprofen, but also to the premature cessation of treatment. The patient should be counselled with regard to the duration of the treatments, and to the possible exacerbation of his condition should he cease treatment too soon. The provision of systemic drugs should be given with caution as, for example, premature cessation of systemic corticosteroid therapy will result in rebound deterioration of the condition. 

Exfoliative dermatitis with fever occurred in a 69-year-old man with ischemic heart disease treated with mex-iletine and diltiazem for three weeks the rash resolved after withdrawal of both drugs and systemic corticosteroid therapy. Patch tests with mexiletine and diltiazem were positive. In addition to this case, 39 cases of drug eruption due to diltiazem have been reported in Japan (16). 

The corticosteroids used in asthma are compared in Table 26-9." Besides acute severe asthma, systemic corticosteroids are also recommended for the treatment of impending episodes of severe asthma unresponsive to bronchodilator therapy. The effects of corticosteroids in asthma are dose- and duration-dependent. This pattern is true for the adverse effects as well (Table 26-10). The clinician must balance the toxicity of chronic systemic corticosteroid therapy continually with control of asthma symptoms. Because short-term (1 to... 

Corticosteroid therapy has been studied and debated in COPD therapy for half a century however, owing to the poor risk-benefit ratio, chronic systemic corticosteroid therapy should be avoided if possible. Because of the potential role of inflammation in the pathogenesis of the disease, clinicians hoped that corticosteroids would be promising agents in COPD management. However, their use continues to be debated, especially in the management of stable COPD. 

The anti-inflammatory mechanisms whereby corticosteroids exert their beneficial effect in COPD include (1) reduction in capillary permeability to decrease mucus, (2) inhibition of release of proteolytic enzymes from leukocytes, and (3) inhibition of prostaglandins. Unfortunately, the clinical benefits of systemic corticosteroid therapy in the chronic management of COPD are often not evident, and the risk of toxicity is extensive and far-reaching. Currently, the appropriate situations to consider corticosteroids in COPD include (1) short-term systemic use for acute exacerbations and (2) inhalation therapy for chronic stable COPD. 

The use of chronic inhaled corticosteroid therapy has been of interest for the past decade. Inhaled corticosteroids have an improved risk-benefit ratio compared with systemic corticosteroid therapy. Using the model for asthma, it was hoped that the inhalation of potent corticosteroid would result in high local efficacy and limited systemic exposure and toxicity. 

The replacement of systemic corticosteroid therapy and its attendant side effects in asthmatic and allergy patients with locally acting corticosteroids by way of aerosol inhalation devices is a gratifying success story. Even though dexamethasone phosphate was initially used for brief periods, the development of systemic effects such as adrenal suppression offered no advantage over oral therapy. Beclomethasone diproprionate showed itself to be hundreds of times more potent, and it produced no systemic symptoms even even on prolonged use with 400 pg daily doses. Some systemic symptoms developed at three to four times higher doses. 

Routine modern therapy of severe exacerbations of asthma includes oxygen in addition to frequent inhalation of p -selective bronchodilators and. frequently, systemic corticosteroids. Therapy of status asthmaticus is more complicated, requiring intubation and respiratory assistance, sedation, parenteral corticosteroids, and bronchodilators. 

Melby JC. Drug spotlight program systemic corticosteroid therapy pharmacology and endocrinologic considerations. Ann Intern Med 1974 81 505-512. 

Inflammatory bowel disease (Crohn s disease and ulcerative colitis) occurs among all age groups but has peaks of incidence in the second and fourth decade of life. Currently, corticosteroid therapy is the most effective treatment for moderate to severe cases of IBD. Ocular pathology in the setting of IBD may be related to inflammation of the gastrointestinal tract or secondary to corticosteroid treatment. The two major ocular side effects of systemic corticosteroid therapy are posterior subcapsular cataract (PSC) and raised intraocular pressure (lOP). Recently, we reported that PSC was detected in 12 of 58 (20.7%) corticosteroid-treated pediatric IBD patients and that 21 patients of the same population (36.2%) had raised lOP. Because pediatric IBD patients continue corticosteroid therapy into adulthood, we analyzed the prevalence of PSC and raised lOP in a series of adult IBD patients. 

Akkoca O, Mungan D, Karabiyikoglu G, et al. Inhaled and systemic corticosteroid therapies Do they contribute to inspiratory muscle weakness in asthma Respiration 1999 66(4) 332-337. 

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