Tapering off small dose of steroids? How?

[BlueHut]

So I’ve had some conflicting advice and am trying to decide the right thing to do. Consultant said my 12y old should take 10mg of Pred for ten days, then stop. Previously the same consultant said one week of 10mg, then one week of 5mg, then stop. This is also what the asthma nurse would prefer her to do. I’m confused and trying to work out if there’s a sensible middle ground. The last thing I want is for her asthma exacerbation to flare up again. Am I overthinking this? Thanks so much.

[elmothebrave]

The way you take the steroids depends on the issue itself. It appears as though this time the consult thinks it needs a stronger and longer hit, rather than the shorter then weaned version. Ring the asthma nurse though and express your concerns. My doctor has never had me on a weaned version, so it just depends I think.

[Chip_y2kuk]

The reason for weaning isn't anything to do with the asthma flare itself its for 'adrenal shock'.... so there's adrenal glands that sit atop your kidneys and there job is to produce 'cortisol' the body's natural steroid now when we take steroids (high doses of Inhaled or tablet) our adrenal glands don't need to produce as much (or in some cases any) cortisol...ace they get a nice rest

However the problem comes when the cortisol replacement suddenly stops abruptly and the adrenal glands suddenly and sharply need to ramp up cortisol production quickly.... they can only go as fast as they can go and sometimes that's not quick enough

Generally most adults (don't know about children) are ok for up to a maximum of three weeks without needing to wean ... however everyone is different and there bodies will respond differently to steroids

However it is gentler on the adrenal glands if your on a high dose of tablet steroids to drop the dose so they have time to take over

Chip

[BlueHut in reply to Chip_y2kuk]

Thanks. 10mg is not a high dose I guess - would it still be better to drop to 5mg before stopping? And how many days of 5mg seem sensible?

[Chip_y2kuk in reply to BlueHut]

I know for an asthma flare for an adult the recommended dosage is 40-50mg for 5 days and if necessary extend the course .... at 50mg I can tell when I've stopped them even after 5 days .... joint aches (which aptly Is also a side effect of steroid use) my kidneys ache and I can feel a bit light headed and weird... I know what it is and I'm also on high doses of inhaled steroids ... so it normally subsides quite quickly (I know my adrenal glands don't do much from the testing I had done a few years ago)

10mg might not be a high dose for an adult but for a child that could be a decent amount sorry I don't know

Now cortisol is responsible for quite alot... blood pressure regulation, blood sugar regulation, temperature regulation.... the list goes on... but they can also be warning signs your dropping too fast if your blood pressure drops etc

I once had to stop everything cold turkey (bit of an experiment with the respiratory consultant) ... I lasted 6 weeks and ended up in trouble but.... after a few days I couldn't stand up without feeling like I was going to faint... my heart kept pounding randomly .... was a very unpleasant experience that they later told me was *probably* my adrenal glands trying to produce more cortisol but not able to produce as quickly as the steroids I'd been taking where leaving me

[BlueHut in reply to Chip_y2kuk]

Thank you!