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Asthma

Asthma only controlled by prednisone?

06/10/2009

Question:

I was diagnosed with Asthma in 2003 six months after moving to Austin, TX. It has only gotten worse and is is now out of control. I have been hospitalized and/or intubated several times. The number seems to be growing every year. Just 2 days ago i had the most severe attack I have ever had. It took 3 ned treatments back to back to stop it and for the first time I feared this was the big one. We have tried several inhalation powders, steriod packs, nebulizer combinations. Prednisone has been the only one able to control it. Now it`s effect is decreasing. I have been taking anywhere from 80 - 60 mg of prednisone regiments for 3 years. Starting with larger dosages and weening down. I used to be able to sustain without the prednisone for longer periods of time. Now I cannot go for more than a two weeks without the prednisone before I start having severe attacks again. My prednisone is taking a very hard toll on my body. Weight gain, bruising, insane mood disorders, last week I smiled and my lip split. My kidney pain is excrutiating. And now my teeth are chipping. I constantly lose the feeling in my legs and my body is retaining so much fluid. Two weeks ago I started to develop a numbness in my right hand. The one thing I did notice was since my diagnoses I spent a few winter months in Crested Butte, Co. I did not have one bad asthma attack. Just a few minor ones.

I went to my doctor again today and received my usual sentence of Prednisone. My doctor asked me to seriously consider moving to change my climate. Do I have to move? Is it possible for me to still live here without relying on Prednisone. Please tell me there are other alternatives?

Answer:

You need to see an asthma specialist based on what you are telling me.  There are often concomitant disorders that could aggravate or present as asthma symptoms that need to be evaluated and excluded or treated.  These included gastroesophageal reflux, vocal cord dysfunction, chronic pulmonary emboli, chronic rhinitis/sinusitis with post nasal drainage, congestive heart failure ....It is also important to rule out severe asthma forms associated with churg strauss vasculitis, APBA, asthma associated with nasal polyposis... An allergy/asthma specialist can also determine if there are factors in your home and/or work environment that could be aggravating or making your condition more refractory.  There are also disease modifying agents that often can get asthma under better control without requiring oral corticosteroids.  As you surmise, in the short term prednisone can be a very helpful medication but when used chronically over and over can lead to serious side effects.  For this reason, seek out an experienced qualified specialist who can make a difference in your life!  I would not make a decision about relocating until you have done this.

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Response by:

Jonathan   Bernstein, MD Jonathan Bernstein, MD
Associate Professor of Medicine
College of Medicine
University of Cincinnati