14 responses to “Role of inhaled steroids in acute asthma exacerbations”

  1. I am an asthmatic myself and have discovered this phenomenon from self treatment. It has become standard therapy for my asthmatic patients.

  2. I would be far more likely to treat with an inhaler before an oral steroid and would certainly never give oral without inhaled. It would seem to be a natural step up treatment to include both.

  3. seems like a good idea, I always stopped the inhaled steroids in exacerbation when I added oral steroids, to save money for the patient, caused me to rethink, good article from Rowe.

  4. Julian,

    Do you leave patients on steroid inhalers indefinitely? Or is this just a 7-day course or until they see their regular physician?

  5. Many asthmatic patients presenting to ER have already used the inhaled steroid (or a long acting beta-agonist + steroid). Do you recommend to try steroid inhalation, or PO steroid under such circumstance?

  6. This is a good reminder. And even if they have a steroid, making sure they use it, and they properly use brings an interesting discussion.

  7. In pediatrics it is difficult for young patients to comply but I have tried this above regime and it works.

  8. V interesting

  9. Interesting article as it is always nice to hear of evidence that supports what we’ve noticed in clinical practice.

  10. Excellent reminder for me!

  11. I do this for many years with great results, even extended the time of relapsed between each episode, and improve the condition of the patient

  12. I have usually not given inhaled steroids when I prescribe systemic prednisone, as often my patients are already on inhaled steroids. But, I will try to be more aware and definitely try this approach.

  13. I would check the technique of using inhaler first, as it may be the cause for failure of inhaler therapy. Oral steroids are certainly the step 3 of asthma management ( after bronchodilator alone, bronchodilator and inhaled steroid- always ensuring the technique)

  14. SIGN and NICE have recommended step wise treatment of asthma- oral steroids are step3.
    JAMA which has been quoted as reference chose patients who were not using initiated into using inhalers, and less than 10% used ICS-step2. Using short course steroids is not exactly step3, but patients are clearly ‘educated’ into step 3, than taking the opportunity of usefulness and technique of inhaler. Even though this is supposed to have happened in the JAMA Cohort, I guess, with a fair bit of cynicism that, this will the practice in the ‘crash, bang, wallop’ ED Patients.
    Dispensing steroids will eventually be norm, just like the abused ativans and T3.-where it would have been an opportunity for education.
    It should rather be, check technique, use ICS, and if fails, the, and only then, oral steroids.
    And, this is with not to mention, the hassle in primary care it will create with coming for the ‘magic pill’
    And, not to mention long term side effects of steroid abuse( yes, yes, I know, we use Ativan and T3 for short term panic attacks and the occasional back pain)

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