From the Guidelines
It is not recommended to treat asthma with prednisone within 2 weeks of a spinal steroid injection without consulting a healthcare provider first, as this may lead to excessive steroid exposure and increased risk of side effects, as suggested by the expert panel report 3 (epr-3) guidelines for the diagnosis and management of asthma 1. When considering treatment for asthma, it's essential to weigh the benefits and risks of corticosteroid use, especially in the context of recent spinal steroid injections. The guidelines recommend short courses or bursts of systemic corticosteroids for establishing control during periods of gradual deterioration, but also caution against potential adverse effects such as reversible abnormalities in glucose metabolism, increased appetite, fluid retention, weight gain, facial flushing, mood alteration, hypertension, peptic ulcer, and rarely aseptic necrosis 1. Some key points to consider when treating asthma with prednisone include:
- Short-term use of systemic corticosteroids, such as prednisone, can be effective for establishing control during exacerbations, but should be used with caution and under medical supervision 1.
- Alternative treatments, such as inhaled bronchodilators or non-steroid medications, may be recommended to avoid potential interactions with recent spinal injections 1.
- Regular follow-up contact with a healthcare provider is essential to monitor asthma control and adjust treatment as needed, with schedule patient contact at 1-month to 6-month intervals depending on the level of control and treatment required 1.
- A step down in therapy may be considered once asthma is well controlled for at least 3 months, with a gradual reduction in treatment and close monitoring to identify the minimum therapy required to maintain good control 1.
From the Research
Asthma Treatment with Prednisone
- Asthma can be treated with prednisone, a systemic corticosteroid, for acute exacerbations of the disease 2.
- The effect of short-term, high-dose prednisone on the hypothalamic-pituitary-adrenal axis (HPAA) is unclear, but studies suggest that it may not have a significant impact on the HPAA in children with asthma 2.
- In adult patients with asthma, oral prednisone has been shown to produce significantly greater suppression of HPA-axis function compared to inhaled corticosteroids 3.
Spinal Steroid Injection Considerations
- There is limited information available on the specific interaction between spinal steroid injections and prednisone treatment for asthma.
- However, it is known that systemic corticosteroids, such as prednisone, can have adverse effects, including hyperglycemia, elevated blood pressure, mood and sleep disturbance, sepsis, fracture, and venous thromboembolism 4.
- The safety of long-term inhaled corticosteroid therapy is a concern, and the effects of these medications on the HPAA axis should be carefully considered 5.
Treatment Timing and Dosage
- The studies do not provide specific guidance on the timing of prednisone treatment in relation to spinal steroid injections.
- However, it is recommended that high doses of inhaled corticosteroids be avoided where possible, and adult patients undergoing high-dose or long-term therapy should be monitored for cataracts and other potential adverse effects 6.
- The decision to treat asthma with prednisone within 2 weeks of a spinal steroid injection should be made on a case-by-case basis, taking into account the individual patient's medical history and the potential risks and benefits of treatment 2, 3, 4, 5, 6.