The roller coaster ride of tapering prednisone
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As a severe prednisone dependent asthmatic, I am all too familiar with the roller coaster that comes with prednisone tapering. Let’s start at the beginning prednisone is a steroid anti-inflammatory drug that has many uses in many diseases. It is prescribed in asthma to treat underlining inflammation which is an underlying driver of asthma.

I am one of those asthmatics that has a significant inflammation component, steroids are a large component of my treatment. I was definitely not excited to become prednisone dependent but I have tried everything and I was out of options that controlled my inflammation the way that prednisone does. I have gone through many bursts for exacerbation or even periods of being on higher doses for some time. It is important to note that every asthmatic is different and may have different experiences with prednisone use tapering. There are many asthmatics that experience side effects and many that do not.

Why is prednisone tapered?

Prednisone is similar to cortisol. Cortisol is naturally produced by our adrenal glands. After extended use of prednisone (generally for a few weeks).1 Your adrenal gland start decreasing the amount of cortisol they produce. The theory is that by gradually reducing the amount of prednisone, the adrenal glands will have a chance to “wake up and start producing their normal amount of cortisol.

Steroids are generally tapered with a goal to get you to the lowest effective dose, as safely as possible. Sometimes this includes what can feel like painstaking slow decreases. At times, I have decrease 1mg a week, yes a week! This process ensured that my adrenal gland have time to wake up and that I don’t incur and rebound symptoms from the imbalance in cortisol production.

You may also be sent for a cortisol test to ensure that your adrenal glands are working.

What are the side effects of tapering prednisone?

The imbalance in the amount of cortisol our bodies produces is thought to contribute to the withdrawal symptoms and side effects that can be attributed to prednisone tapering. If I have to choose one of the side effects that i thought I was most greatly affected by. It would be the fogginess of my brain otherwise know as my reduced concentration. It makes trying to get work done, very difficult. There is also the crazy joint pain. These are just a few of the symptoms that may be encountered. The good news is that they are fairly short in duration and seem to mostly resolved when your adrenal glands take over. Of course, this will differ, if you are like me on a maintenance dose of prednisone, you may still encounter other side effect from your maintenance dose.

I have had a range of experiences with prednisone tapering if I am on high doses following an exacerbation. I can generally decrease down to 15mg or even 12.5mg, fairly easily without too many unwanted side effects. In my experiences I have had to taper more slowly to get down to a maintenance dose. In many circumstances, an asthmatic patient will be completely tapered off of it. If you have tapered off of steroids or decreased to a maintenance dose, you may also know what your threshold are or how you need to adjust your tapering schedule to decrease the side effects.

view references
    1.http://www.mayoclinic.org/diseases-conditions/asthma-attack/diagnosis-treatment/treatment/txc-20257835
  1. Alangari AA. Corticosteroids in the treatment of acute asthma. Annals of Thoracic Medicine. 2014;9(4):187-192. doi:10.4103/1817-1737.140120.
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