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If you are unresponsive to commonly used controller and reliever asthma treatments, you may require long term use of daily or alternate-day corticosteroids. This treatment is used for the most difficult to manage asthma and requires frequent evaluation to assess medication effectiveness and side effects. Steroid-sparing treatments can be used often with some degree of success.
In general it is always best to administer the smallest effective dose of a shorter acting oral corticosteroid (e.g. prednisone or methylprednisolone) to reduce the potential risks of side effects. This is best managed through a program of regular office visits where your current symptoms, physical examination and pulmonary functions all can be analyzed for appropriate decision making. If you require an acute burst of oral corticosteroids, The Asthma Center specialists recommend that you be seen in follow-up visits within 48 to 72 hours of corticosteroid treatment. This acute follow-up visit is important in evaluating effectiveness of treatment, assessing potential side effects and planning a dose taper program.
Long acting corticosteroids such as dexamethasone (Decadron®) or any type of depot (slow release) corticosteroid injection should be avoided except under extraordinary circumstances. Once this latter type of corticosteroid is injected, it cannot be removed from the body and will slowly be released over weeks or months. Although an injection of depot corticosteroid may seem convenient, The Asthma Center specialists do not consider its use as a wise approach to the management of asthma when more flexible and safer programs are available.
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