Question: I was diagnosed with Cushings “syndrome” due to usage of too much prednisone for the treatment of asthma. I’m constantly on 50mg of prednisone because I keep getting flare-ups of my asthma even with adding Spiriva, Symbicort and Ventolin. By the time I wean down to 2.5mg of prednisone, I again get another cold which goes to my lungs and I’m forced once again to go back to the 50 mg dose of prednisone. How do I get off this merry-go-round?  

Answer: This is an important issue. Unfortunately, some people do require high dose steroid treatment for the control of asthma. While the first step to minimize steroid exposure is always to try other medications that may control the asthma, in this case, it appears that has not been successful. The patient should ask the asthma doctor if it is possible for him/her to be controlled on a regular more physiologic daily dose of prednisone (like 7.5 mg/day)? This dose, 7.5 mg/day, is a usual replacement dose and if he/she can be controlled on this type of dose, it may prevent the need to go to such high doses of 50 mg/day, which is terrible for the bones. If the patient requires chronic prednisone treatment, they will need a MedicAlert bracelet/necklace stating “adrenal insufficiency”. The patient should also be working with an endocrinologist who should monitor for diabetes, hypertension and bone density. If osteoporosis develops, there are good treatments available. The endocrinologist should also be monitoring Vitamin D levels and the patient should discuss taking Vitamin D and Calcium with the endocrinologist. I would also recommend low impact (on skeleton) exercise such as swimming daily if possible.

By Dr. Mary Lee Vance, Summer, 2014