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Prednisone – A Necessary Evil!

Prednisone is one of those nasty medicines that I dread, but sometimes it’s necessary when you have asthma.

For my kids, a course of prednisone (oral steroids) could sometimes prevent a trip to the hospital. We seemed like we had a 50/50 chance of preventing a hospitalization, but it was always worth the try!

Prednisone works really well to take the swelling down in your lungs. For the every day swelling that is part of asthma, my kids and I all use a controller inhaler. But sometimes, we can get really sick with bronchitis or pneumonia, and the regular controller inhaler just can’t get us through the rough patch.

Prednisone: a last resort for many

For us, it’s a sort of last resort to use prednisone. We will get more medication with prednisone (even for 3-5 days), than if using a daily, controller inhaler to keep the swelling down in our lungs. Why?

A controller inhaler is just that – inhaled – so the medicine goes in the lungs. Prednisone is given as a pill or liquid version and since you swallow it, it goes through your ENTIRE body – lungs, liver, kidneys, etc. It’s called a “systemic steroid” because it goes through your whole system.

How much more medicine would you get with one burst of prednisone, vs your daily inhaler (sometimes called an inhaled corticosteroid, or ICS)?  One doctor did a little math to figure it out. This is what he said:

“In order to explain why regular ICSs are a good choice, I’ve got to do a little math. Let’s say you were just using a rescue inhaler for asthma control and that during the last year you only required one course of oral steroids, prednisone. A usual prednisone “burst” is 40mg a day for 5 days for a total of 200mg or 200,000mcg. By way of comparison, each dose of Advair 100/50 contains 100mcg of fluticasone, the steroid. If you took Advair 100/50 twice a day, the usual dose, it would take you 1000 days of regular use to equal the amount of steroids in one burst of prednisone on a mcg-per-mcg basis.”

So, we would rather take our daily inhaler, be exposed to less medicine over time, and have less side effects. But, sometimes we have no choice but to have a burst of prednisone.

The “cons” of prednisone

It can literally be a life saver- but it can have a LOT a side effects. Some of the common side effects are:

  • sleep problems
  • headache
  • dizziness
  • mood changes
  • increase in appetite
  • nausea, etc

It can also impair the immune system – which is a problem if you have asthma. The last thing you want to get is a cold, because it can turn into bronchitis or pneumonia. In fact, we are having that problem now.

Middle Son is in college and had a nasty case of bronchitis which required prednisone and an antibiotic. He was almost better until the Hubster brought home a terrible chest cold as a souvenir from our trip to Hawaii. Since Middle Son had an impaired immune system, and the Hubster’s cold was a different strain, Middle Son started a new battle with bronchitis – but it was much worse this time. He ended up on a 2nd antibiotic and was really struggling to breathe. It was scary. (It doesn’t matter how old my kids get, I’m going to worry – especially if they can’t breathe!)

Then, a few days later, he picked up a stomach bug. Poor guy! I think he picked up the 2nd cold and the stomach bug because he had been on a course of prednisone – which suppressed his immune system.

Everything has been disinfected, and we wipe down all of the surfaces every day to try to keep the germs away. But Middle Son still has to go to work and college (campus size is 30,000 students – can you imagine all of those germs?!)

If you do very sick and your doctor recommends prednisone, “the necessary evil”, discuss the benefits and side effects with her.

For us, the biggest benefit is that my son is still breathing and not in the hospital again. I’ll take prednisone over that any day.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • John Bottrell, RRT moderator
    2 years ago

    Excellent post, Andrea!!! I love the way you explain this. Thanks. John.

  • seaturtle08
    2 years ago

    For me, prednisone (and, unfortunately, its IV equivalent) were a necessary evil for me multiple times between fall 2014 and early spring 2017. I experienced the increased anxiety, the insomnia, the increased appetite. I hated how it made me feel for the 5 or 10 or 20 days that I was on it each time. After a paticularly bad bought of strep that exacerbated my asthma and landed me in the ICU intubated and receiving IV steroids, I woke up with minimal muscle function in my legs. Steroid myopathy, muscle wasting or weakness- it’s on the list of side effects, under “incidence not known.” I’d never heard of it; never known that prednisone and other systemic steroids could have that effect, until I was living it. 6 months relearning how to walk and still not 100% at 10 months. My pulmonologist is concerned that if I were to be on steroids again, I could develop myopathy more easily (there’s not a lot of research, especially on younger patients) and that it could affect my diaphragm, making it very difficult to wean me off a vent if I was intubated. So, I have to manage without systemic steroids…it means being compulsive about my daily meds, calling the doctor at the first sign of a cold or throat infection, and, sadly, spending more time in the hospital…even when it’s not “hospital bad” I can’t just go home with a script for prednisone, so I wind up getting admitted for monitoring and around the clock breathing treatments…
    So, take the necessary evil if you can. Sometimes, I wish I still could.

  • John Bottrell, RRT moderator
    2 years ago

    Hi. seaturtle08. Good advice. Sorry to hear you had such a hard time with your asthma, and can’t use oral steroids. It does seem you have a pretty good grasp of your asthma and how to manage it. Wishing you all the best. Keep us posted. John. Site Moderator.

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