The Asthma Center

Alternate-day oral corticosteroid treatment

When inhaled corticosteroids and other medications fail to control severe asthmatic symptoms, alternate-day corticosteroid therapy may be considered as a treatment option.

In order to minimize the potential for side effects, many specialists may recommend treating you with a low dose oral corticosteroid with a shorter half-life such as prednisone or methylprednisolone (Medrol®) every other morning. If you take these short acting corticosteroids as soon as you wake up in the morning, the medication will have a limited suppressive effect on the adrenal glands for only one day. On the following morning, your adrenal glands may resume their normal production of corticosteroids. The day of corticosteroid treatment is usually referred to as the "on" day and the day that the corticosteroid is not given is called the "off" day.

Since the adrenal suppressive effect can last 12 - 24 hours, it is very important to take oral corticosteroid medications early in the morning as soon as you awaken. Taking the medication later in the day to catch up because you forgot the morning dose defeats the goals of this maintenance program. Administration of corticosteroids on an every-other-morning treatment plan is called alternate-day therapy. Since the anti-inflammatory or anti-asthma effects of corticosteroids appear to last longer than their suppressive effects on the adrenal glands, this approach gives you the benefits of oral corticosteroid therapy with little or no side effects when used in low doses.

Alternate-day oral corticosteroid treatment is a sophisticated type of therapy, and you must be under close supervision by a knowledgeable physician if involved in such a program.