Cushing Syndrome and Steroid Use in Asthma
I was reminded today that while many doctors may put patients on steroids to control inflammation related to asthma, there is very little conversation about what life on steroids is like, or potential side effects, such as Cushing syndrome. For patients that experience these side effects, it is important that they have the information about what to do when to contact a practitioner, and anything they can do to minimize exacerbating side effect risks.
What is Cushings syndrome
You may be asking yourself, what is Cushing syndrome. Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long time. Cushing syndrome is sometimes referred to as hypercortisolism. The condition can also occur when your body makes too much cortisol on its own.1
Too much cortisol in your body has been associated with — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss, and, on occasion, type 2 diabetes. Cushing features may develop within the first two months of GC therapy, and the risk of these complications appears to be dependent on both the dose and duration of treatment. Just like no two patients are alike, not everyone may experience all or some of the symptoms.1,2
Treatment for Cushing syndrome
Treatments for Cushing syndrome include returning your body's cortisol production to normal, this noticeably improves your symptoms. The earlier treatment begins, the better your chances for recovery. The catch with treatment is that in some circumstances the best way to treat the Cushing may be the discontinuation of steroids which can have definite impacts on asthma stability. Your doctor will prescribe a plan that will work best for you. This may include the addition of another treatment and a plan to taper your steroids over a period of time.
The challenge is that in some cases, doctors skip over the part about what effects steroids can have over time. This is why as patients we need to be as proactive as possible to ask what the potential side effects are and how these will be monitored and what potential treatments are available. No one likes side effects or seeing changes in your body. It is important to communicate any changes that you are experiencing or any potential side effects with your care team. The side effects of prednisone are somewhat controversial as individual responses differ. There are thoughts that there is a smaller rate incidence of experiencing side effects at doses of 7.5mg of oral corticosteroids daily. In many patients, this daily dosage is well tolerated.3
Personally, I have struggled with Cushing a few different times. While the symptoms have been brutal from time to time, I have been able to work on making improvements. My personal experiences have included a reduction of my oral prednisone dose and the use of some prednisone sparing strategies. If you are bothered by these symptoms it is important to discuss your feelings with your physician as there may be other options out there for you.
Do you prefer to use a spacer or no spacer?