How To Use Metered
With metered-dose inhalers being the most widely used among all inhaler types, this might be the kind you might be familiar with. Here are the steps to use a metered-dose inhaler:
Step 1: Take off the cap of the inhaler and shake the inhaler well.
Step 2: Hold the inhaler in an upright position and stand up or sit up straight.
Step 3: Exhale and breathe out all the air in your lungs as you tilt your head slightly backwards.
Step 4: Hold the mouthpiece between your teeth, close your lips around to achieve a proper seal.
Step 5: Start breathing in slowly through the mouth and press down the canister fully to release one spray. Continue breathing in slowly and deeply. This coordination is important to follow to ensure the proper dose of the medication is delivered.
Step 6: Remove the inhaler from your mouth.
Step 7: Hold your breath for ten seconds, or as long as you comfortably can, and breathe out slowly.
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Coping With Side Effects Of Steroid Inhalers
The following tips may help reduce the side effects of steroid inhalers:
- use your inhaler exactly as you’ve been shown speak to a doctor or nurse if you’re not sure how to use your inhaler correctly
- use your inhaler with a spacer, a hollow plastic tube or container with a mouthpiece at one end and a hole for the inhaler at the other
- rinse your mouth out with water and spit it out or brush your teeth after using your inhaler
If you’re taking a high dose for a long period of time, you may be given a steroid treatment card that explains how you can reduce the risk of side effects.
Why Might You Need Oral Corticosteroids
You might be prescribed a short course of oral corticosteroid to help regain asthma under control during a flare-up or asthma attack.
Your doctor may include oral corticosteroid medication on your written Asthma Action Plan as a step to take if your asthma worsens. Asthma Action Plans that include instructions for the use of oral corticosteroids as well as instructions to increase the dose of inhaled corticosteroid, are effective in improving lung function and reducing hospital admissions.
Needing two doses of oral corticosteroids in a year is a sign of uncontrolled asthma. If you need to use oral corticosteroids more than twice a year or for long periods, it is important to discuss other options with your doctor for improving your asthma control.
This might include:
- Checking your inhaler technique to make sure you are getting the most from your preventer
- Discussing the possibility of add-on therapies for your asthma
- Addressing other health conditions impacting your breathing.
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Detailed Information On Symptoms Medications And Treatment Of Asthma
When the cortisone treatment for asthma was introduced many patients and even doctors were apprehensive. The word steroid was enough to scare anyone of the cortisone based inhalers. Most have heard of anabolic steroids used by athletes to give them a surge of energy. Anabolic steroids were also used to build muscle mass and boost testosterone, the male sex hormones. Anabolic steroids are fraught with serious side effects like stunted growth, liver damage, elevated blood pressure, cholesterol level surge, coronary heart disease etc. As a result of this steroid phobia, doctors used to prescribe cortisone medicines for asthma only in extreme cases.
Nowadays the trend has completely changed. Doctors and patients have realized that cortisones are different from the anabolic steroids. Asthma specialists now invariably give a short burst of cortisone to most patients with even with mild to moderate. The common drug of choice is prednisone. It is now widely accepted that even oral doses of this medicine used for shorter duration has much lesser side effects. The therapeutic effects of prednisone can be seen as early as two hours after the initial dose. With the prompt use of prednisone the need for acute emergency visits or hospitalization in both children and adults comes down drastically.
If You Have Asthma Your Healthcare Team Will:
- Explain how you can keep your asthma under control by avoiding your personal triggers
- Prescribe medication that will help minimize your symptoms
- Show you how to take your medication properly, checking your inhaler technique
- Work with you so you have a written Asthma Action Plan
- Recommend that you visit on a regular basis so that your symptoms can be monitored and your treatments adjusted if necessary
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Types Of Medicines Usually Prescribed For Asthma
Bronchodilators relax the muscles around the airways . When the airways are more open, it is easier to breathe. There are two general types of bronchodilators, and you may be prescribed one or both types:
- Short-Acting bronchodilators work quickly after you take them so that you feel relief from symptoms quickly.
- Long-Acting bronchodilators have effects that last a long time. They should not be used for quick relief. These medications are only recommended for use when combined with an anti-inflammatory asthma medicine .
Anti-inflammatory medicines reduce the swelling and mucus production inside the airways. When that inflammation is reduced, it is easier to breathe. These medicines also are called corticosteroids or steroids. Most often, these are inhaled medications and it is important to rinse out your mouth with water immediately after using them to avoid getting thrush, a yeast infection in your throat.
Some corticosteroids come in pill form and usually are used for short periods of time in special circumstances, such as when your symptoms are getting worse.
There are a few medicines that combine inhaled bronchodilators and inhaled corticosteroids.
Side Effects Of Oral Steroids
It is helpful to understand the differences between oral corticosteroids and inhaled steroids. The most important of these are related to potential side effects, which may become more pronounced when drug levels are not stable. This can occur when prescription instructions are not followed exactly as directed.
The half-life of oral corticosteroids is significantly longer than inhaled steroids, and therefore oral steroids have a more significant side effect profile, including:
- Decrease in bone density and possible osteoporosis
- Aggression and other changes in behavior
- Increased appetite, fluid retention, and weight gain
- Increased risk of infection
It is key to mention any recent steroid bursts to your healthcare provider. Overuse of oral steroids may prevent your adrenal gland, where your body’s natural steroids are made, from working correctly. As a result, your body may not make steroids sufficiently during a time of stress and you may require additional supplementation.
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How To Use Your Accuhaler
To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to explain how to use your accuhaler. Here is some guidance:
Using your accuhaler
- Open: hold the accuhaler in one hand, and with the thumb of the other hand push the thumb grip away from you until you hear a click. This reveals the mouth piece.
- Load the dose: hold the inhaler in a horizontal position. Slide the lever away from you until you hear a click.
- Breath out: breathe out, away from the accuhaler. Do not blow directly into your device.
- Inhale your dose: place the mouth piece in your mouth and form a seal with your lips. Breathe in deeply and forcefully through your mouth. Remove the accuhaler and hold your breath for up to 10 seconds. If you need another dose, wait for 30 seconds and then repeat the process
- Close: the inhaler by sliding the thumb grip towards you.
Cleaning and storing your accuhaler: wipe the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. Close the device when not in use. When to start a new accuhaler: there is a window on the side of the accuhaler called a dose counter. When it turns red it is time to get a new accuhaler.
What Is The Dosage Of Prednisone To Be Taken To Work For Asthma
As mentioned above, prednisone is available in either an oral liquid solution or as an oral tablet. Prednisone is similar, but not the same, as methylprednisolone, which is available as an injection. Oral prednisone is generally used in cases of acute asthma as a first-line therapy as prednisone is easier to take and cheaper than other corticosteroids available today.
Prednisone is generally prescribed for 5-10 days. Steroid medications are not generally prescribed for children. In adults, on the other hand, the general dosage is not to exceed 80 mg. The common dosage is 60 mg. Studies have shown that a dosage above 5- to 100 mg per day is not more beneficial than lower dosages.
In case if you miss your prednisone dosage, then it is to be taken as soon as you remember or if its already time for the next dose, then the missed dose should be skipped and the next scheduled dose should be taken. Doctors advise against taking an extra dose of prednisone to make up for a dose that has been missed. Prednisone is best taken with food or milk as otherwise it can lead to an upset stomach.
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Are There Any Side Effects
Because the amount of corticosteroid via a puffer is so small, side effects are uncommon. Some people on inhaled corticosteroids may have local side effects such as: sore throat, husky voice, thrush in the mouth.
These side effects can be avoided by using a spacer. Brushing teeth and rinsing mouth with water and spitting out will also help. Inhaled steroids are not addictive.
Your doctor will help to choose the right dose.
What Are The Implications
This study strengthens the evidence for asthma self-management and the strategy of quadrupling the dose of inhaled corticosteroid to reduce exacerbations.
Although it follows recommendations in the existing NICE guideline, previous evidence had not been strong. This studys findings increase confidence in the research underlying current recommendations and give a quantitative estimate of the benefit.
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How Long Do Steroids Stay In Your System
If you are taking steroids for asthma, you may wonder how long steroids stay in your system. This will vary depending on the type of drug, whether you are taking an inhaled medication such as Advair or oral corticosteroid , and the characteristics of each medication. Specifically, the drug’s half-life will determine how long a drug circulates within your body.
Hugo Lin / Verywell
To Control Asthma Start With The Home Instead Of The Child
“I’m a low-BMI white woman with a history of autoimmune disease, which puts me at high risk for osteoporosis,” says Leigh.
When she read the study, Leigh says, she was frustrated to learn that the $500 asthma inhaler she uses one that increases her risk of breaking a hip in a few years might not even work.
“I don’t know where I go from here,” she says. “Do I continue with the medication, or do I stop and end up in the emergency department?”
Lazarus suggests she follow her doctor’s current recommendation. While the study suggests that guidelines on treatments for mild asthma may ultimately shift, a bigger, longer study is needed, Lazarus says, before any major clinical changes are made.
“If someone has evidence of episodic, periodic asthma and asthma exacerbations that lead to emergency department visits and they respond when treated with inhaled steroids, then it kind of doesn’t matter what the lab test shows,” he says. “If they have a clinical response that is genuine, that probably is an appropriate treatment regimen.”
But in general, he says, there is no magic lab test that can say which asthma patients will respond to inhalers and which ones won’t.
“I would say that if you have people who are taking inhaled steroids and they’re not responding, the answer is not necessarily to just continue to escalate the dose,” he says, “but to question whether there’s an alternative.”
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Coping With Side Effects Of Steroid Tablets
The following tips may help reduce the side effects of steroid tablets:
- take your tablets in the morning with breakfast this may help prevent indigestion, heartburn and sleeping difficulties
- eat ahealthy, balanced diet and exercise regularly this may help prevent weight gain and osteoporosis
- avoid close contact with people who are ill especially people who have measles, chickenpox or shingles get medical advice as soon as possible if you think you may have been exposed to someone with an infection
- ensure your vaccines are up-to-date but do not have any “live” vaccines, such as the shingles vaccine
Your doctor may reduce your dose or suggest taking your tablets less often if you’re having side effects.
They may also sometimes recommend other medicines to take alongside steroids to protect you from some of the side effects, such as medicines to help prevent indigestion or heartburn, or medicines that help strengthen the bones.
You may be given a special steroid treatment card that explains how you can reduce the risk of side effects.
History Of Oral Corticosteroids Use In Asthma
Before the 1950s, the treatment for asthma was restricted to those compounds that were either plant-derived or adrenaline derivatives. This treatment consisted primarily of bronchodilator agents.4 With the development of steroid and adrenocorticotropic hormone extracts, a 1952 seminal study by McCombs noted the marked improvement that could be derived with respect to asthma symptoms and control using either corticosteroids or adrenocorticotropic hormone.5 It has since been determined that oral and parenteral corticosteroids have no significant difference in bioavailability, and thus oral corticosteroids are by far the most common formulation of systemic corticosteroid used in the treatment of asthma today. It was not until 1958 that the association between successful treatment with OCS and a reduction in eosinophils in the sputum was noted.6 This revelation opened the door to widespread treatment with OCS, both on a chronic and acute basis,4 but with this came increasing recognition of the side effects of systemic corticosteroids. The subsequent development of inhaled corticosteroids and the recognition that these can be equally as effective in the majority of patients with asthma, therefore, led to a decline in the use of OCS, except in the population with severe asthma.7
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How To Cope With Side Effects
What to do about:
- weight gain – try to eat well without increasing your portion sizes so you don’t gain too much weight. Regular exercise will also help to keep your weight stable.
- indigestion – take prednisolone with food to reduce the chances of stomach problems. It may also help if you avoid rich or spicy food while you’re taking this medicine. If symptoms carry on, ask your doctor if you may benefit from taking an additional medicine to protect your stomach.
- sleep problems – take prednisolone in the morning so the levels are the lowest at bedtime
- restlessness – if you’re restless when you’re trying to sleep, take prednisolone in the morning so the levels are the lowest at bedtime
- sweating a lot – try wearing loose clothing, use a strong anti-perspirant and keep cool with a fan. If this doesn’t help, talk to your doctor as you may be able to try a different medicine.
Side Effects Of Prednisone
You may start seeing side effects if you take prednisone more and longer than required. Some of the side effects that you might experience include:
- Difficulty sleeping
- Increased blood sugar and blood pressure levels
- Glaucoma or cataracts
As it is a steroid, abuse of prednisone does occur. This may be for people who want to increase their general fitness or who want to gain an advantage in sports. Even short term use can have detrimental effects with one in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events according to a 2017 study.
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Randomisation And Baseline Visit
After enrolment, the patients will be randomly allocated to one of the two treatment groups . The randomization schedule will have been previously generated using a computer. Randomisation will be blocked with randomly chosen block lengths of 4 or 6. Treatment assignments will be written on a piece of paper and concealed in sequentially numbered opaque envelopes kept in a secure locked location in the study research office. The PI and analyst will be blinded to the treatment intervention, but the research assistant in charge of screening and randomising patients, as well as the patients treating team will not because of the pragmatic nature of the trial. Demographic data will be collected at baseline.
Pathophysiology And Mechanisms Of Action Of Oral Corticosteroids In Asthma
The anti-inflammatory nature of OCS is the key to their efficacy in asthma. At present, it is suspected that at least half of all patients with asthma have predominantly eosinophilic inflammation, including the majority with early onset disease associated with allergy.8 It is this population with eosinophilic inflammation that are the best understood and studied, especially with respect to the efficacy of corticosteroids. In these individuals, a complex interaction between genetics, airway damage and a maladaptive immune response within the airways leads to the development of asthma.9 Meanwhile, re-exposure to allergen, infection or other irritants initiates an inflammatory pathway mediated by cell signalling molecules, namely interleukins -4, 5 and 13. The term type 2 inflammation has been used to describe this eosinophilic pathway for inflammation in the patient with asthma, which is differentiated from non-type 2 inflammation, thought to be predominantly associated with neutrophilic or paucigranulocytic sputum phenotypes, and with potentially different pathobiological mechanisms. The inciting irritants and subsequent type 2 inflammatory cascade lead to recruitment of mast cells, eosinophils and CD4+ T lymphocytes and further release of their associated type 2 cytokines. The presence of this inflammation is associated with increased thickness of the smooth muscle layer, excessive and variable airway narrowing and increased secretion of mucus.10
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