From: brandon@caldonia.nlm.nih.gov (Brandon Brylawski)
Subject: Re: asthma prednisone allergy
Organization: National Library of Medicine
X-Newsreader: Tin 1.1 PL4
Date: Wed, 27 Jan 93 15:28:48 GMT

stellr@smyrna (Ray Stell) writes:
: My 10 year-old son has had two exercise indused asthma attacks
: before this year.  He has had three attacks since last summer
: that were chronic in nature (not an event, but rather his lungs
: developed a wheeze that progressively got worse).  Those three
: times his gp prescribed a strong/week-long cycle of prednisone.
: Each time this cleared his lungs.
: 
: The second event/treatment, last October, left him with a
: chronic stomach ache, a known side-effect (we guess the
: prednisone did it, they did an upper gi, in December, no ulcer 
: detected).
: 
: "The Complete Book of Children's Allergies, A Guide for Parents",
: by B. Robert Feldman, M. D., from Columbia Presbyterian Med
: Center, ISBN 0-8129-1211-X, lists the side-effects of extended
: steriod use, and my son showed most of them within days, weight
: gain (5 lbs, in a week), moon face, headache, insomnia, bad
: stomach ache, etc.  The text says that this is not supposed to 
: happen until after two weeks of use. 
: 
: So, why does he get these side-effects?  Is the dose to strong?
: I assume this will happen again, in the spring, when the plants
: are active, he has always had allergies to various pollens,
: dust, molds, etc.  Should we avoid prednisone?  If so, when his
: lungs are stressed, what do we do?  He already takes the daily 
: inhaler of cromolyn sodium (Intal) and uses albuterol sulfate
: (Ventolin) when he begins wheezing.  He has taken the Intal,
: daily for the last year and a half.
: 
: I don't want to give him the steriod again.  What are the
: alternatives? 
: ======================================================================
: Ray Stell		stellr@smyrna.cc.vt.edu		(703) 231-4109

Some people are much more sensitive to steroid side-effects than others, and your
son may be among these. It's hard to say whether the dose is appropriate without
knowing the dose and how much your son weighs, though. 

  There are several other things you should try doing.

1. Continue using the intal regularly.
2. Use the ventolin one-half to one hour BEFORE exercising; many with exercise-induced
asthma can avoid attacks by doing this.
3. Use the ventolin regularly (2 puffs four to six times a day) whenever he seems to 
be having an allergy attack or a cold, or is otherwise having trouble, and as needed.
Ventolin has for most people no side effects, even when used daily, and you
can't really overdose on it (if you use it too much, it may make your heart race or
make you jittery, but rarely anything else).
4. If the above still don't help, consider a steroid inhaler (sample brand names
azmacort, beclovent; avoid aerobid - it tastes bad). These are very effective but
have many fewer effects than oral prednisone because the dose is MUCH smaller.
If his problems are seasonal, he could use a steroid inhaler for just those times of
year, which would minimize side effects as well. One note about steroid inhalers -
brush your teeth or rinse your mouth out after every use, to avoid a yeast infection.
5. An overall point: make sure he's using the inhalers properly. The idea is to
get the medicine into the lungs, not spray the back of the throat. Many patients
put the inhaler in their mouths, spray, and inhale; this wastes most of the medicine.
(I've even seen package inserts that say to do it this way, but they're wrong.)
Hold the inhaler about one inch in front of your wide-open mouth. Breathe out all the
way, then take a deep breath. Fire the inhaler AS YOU ARE BREATHING IN. Hold the
deep breath for a few seconds, then inhale. repeat once.

Good luck,

Brandon Brylawski, MD