How long should oral steroids be taken ?

[Hannah125]

Hi!

I'm currently suffering from an asthma flare up (I've posted about this before) and I'm struggling to gain control over it. My asthma has never been this bad I even had no idea it could be like that. So I started a short course of oral steroids 5 days ago hoping it would calm the inflammation and help my lungs heal but so far it has done nothing. I still struggle to breathe and have a tight chest, I still need to take ventoline and nebuliser several times everyday. I still can't resume my normal activities without getting out of breath and it's been 4 months. So my question is, how long are we supposed to take these pills to get rid of a flare up ?

Thank you!

[Tezwik]

When I take my steroids I usually have to call the GP and let them know and they book me in for a quick check up and replacement pack and then if things haven’t settled by the end of the pack I let them know and get another appointment, maybe give the GP a call

[Ted007]

Hannah, I have just been put on a course of steroids lasting 3 months, which I am not happy about. So they can be taken reasonably long term. That said, they are damaging and should be used as little as possible. It sounds as though you need to see a specialist and plan a course of action that will take you away from oral steroids.

I found the oral steroids generally work well for gaining control - unless I have a chest infection. In which case I normally clear the chest infection with anti-biotics then use the steroids. Hope this helps Ted

[hilary39]

Ugh the prednisone merry go round! People often call it the devil’s candy which I think is fair

I have been on dozens of courses over the past several years for as little as five days and as long as eight weeks. Given your symptoms are still flaring, it sounds like you may need to be on them longer. It can be frustrating given the side effects (I have a hard time focusing and get moody and gain weight) but they do work eventually and are unfortunately one of the only stop gaps to end asthma severe flares.

A few things: (1) i’d ask your doctor to check your cortisol if you’re on prednisone for longer than ten days; I recently had an issue with my cortisol plummeting (tho it was after two months on steroids) and I had to take a lot of hydrocortisone to repair my adrenal glands. No one had ever told me it that was a potential issue so just wanted to share that-

(2) are there new allergens in your environment that could be contributing to this sudden flare? Do you run an air purifier at home?

Sorry to hear you’re miserable. I’ve been in a bad flare myself since January I can’t seem to snap out of so I empathize. Just started xolair and am hoping it’ll help.

Take good care!

[Hannah125 in reply to hilary39]

Hi!

Thanks for your advice. Unfortunately my doctors are not really open to questions so it's a great thing that this website exists! I do suffer from an allergy to dust mites but it has never caused me any trouble before. My asthma actually went crazy because of the flu I suffered from 4 months ago and it seems to be getting worse.

I've been taking the oral steroids for 5 days (40 mg/day) and now my doctor told me to taper for two more days with only 20mg. So I only took 20 mg today but I'm not sure if it will be enough to avoid any problems. The side effects of this drug are becoming a little hard to handle for me so I'd rather stop it and continue with inhaled steroids which I hope can also help calm the flare up.

[hilary39]

Yeah the side effects of steroids are rough. I’m sorry you're feeling so terrible It’s amazing how a bad cold or flu or exposure to an allergen can kick off a many-month flare. But remember steroids are your friend in really bad flares—you don’t want to avoid them if you’re in a situation where you really need them since asthma can get dangerous for those of us with moderate or severe persistent asthma. (I’m just repeating advice my old primary care doctor gave me, he was great and really took time to understand my asthma—a rarity!) keep advocating for yourself and I do hope you’ll find relief soon.

Also you may want to taper one more day at 10 or 5 mg. I sometimes find it’s rough to go from 40 —> 20 —> 0. Doctors often cite a study that showed 5 days at 40 mg is short enough to stop without tapering but everyone’s bodies are different and I know that I feel awful when I don’t taper.

[Brittleasthmatic]

Im sorry you've been so unwell. I know prednisolone can be a nightmare! You will be ok not to taper if you've just had a 5 day course. The side effects are terrible but my consultant always reminds me they are life savers . Unfortunately this will be my third month and 2nd week on prednisolone. .. Every time I try to wean off I get poorly again and re prescribed back up to 40 mg. I have had terrible side effects including weight gain and my hair falling out, but I know the doctors wouldn't give me them if it wasn't necessary.

I hope you feel better soon x

[Hidden]

Hi Hannah, I have a love/hate relationship with steroids tbh as they have caused me so many serious side effects...yet at the same time they have helped save my life because they’re brilliant at reducing the inflammation in airways and lungs.

I have been on them much more often than not and have needed to have intramuscular injections twice this year. They are a massive dose of corticosteroids and as effective as they are the downside is that, unlike the oral steroids you have no control over the dose.

For short courses of steroids you don’t need to do the gradual wind down by decreasing the dose but if you’re on longer courses over a period of months you need to decrease the the dose in increments ..your GP can advise you on this.