Is Prednisone a Friend or Foe?
Probably just about everyone who reads this monthly Newsletter knows about prednisone. Prednisone is in a class of drugs called corticosteroids, related to the cortisone group of medications. These drugs are highly useful in the management of asthma and some patients with COPD, and, quite frankly, I couldn’t get along without them in my practice. This statement has to be tempered with the clear understanding of what I call the “downside” of these valuable drugs, and these can be substantial. Yet many of the side effects can be avoided or minimized with certain strategies.
Prednisone is an anti-inflammatory drug and thus deals with inflammation of the conducting air passages in the lung. Inflammation may be present in both asthma and COPD. The strategic use of prednisone can soothe and thus heal the delicate lining layer of these passageways, making them more resistant to bronchospasm. Prednisone has another effect in preserving or even increasing the receptors for inhaled bronchodilators. Thus prednisone is used both to combat inflammation and to enhance the effectiveness of one of the most valuable bronchodilators we have for asthma and COPD. The downside is well-known. It causes wear and tear on the bones, and in some patients the acceleration of cataract formation and the worsening of glaucoma (high pressure in the eyes). The bone problem is much worse in women than men, and it is a particular problem in small-boned, light-skinned women beyond the menopause. On the other hand, large-boned, dark-skinned people have relatively little trouble with prednisone. Men have far less trouble than women, probably because their bones are larger to start with. The bone problem (osteoporosis) can be largely prevented by the appropriate use of calcium. A quart of skim milk gives 1,000 mg of calcium, and simple medications such as Tums contain a lot of calcium. Physicians believe that between 1,000-1,500 mg per day is necessary to help prevent osteoporosis. Exercise also helps protect the bones, and, of course, being able to breathe makes this exercise possible. (Newer medications have become available to help treat osteoporosis).
Anybody receiving long-term prednisone should have an annual eye exam and, of course, plenty of people have cataracts and glaucoma without the use of steroids. If steroids are making things worse, that fact can be dealt with by using medications and surgery. Short courses of prednisone cause almost no harm, and even low maintenance doses given each morning or evening in a single daily dose have minimal side effects in most patients. Most of the other rumors about prednisone are blown way out of proportion, but it is true that some folks have more trouble from prednisone than others. It’s hard to discuss all of the ins and outs of prednisone therapy in one short Newsletter, but the “bottom line” is prednisone is very useful in many patients and usually does a lot more good than harm. I’ll be in touch with you next month with more information on prednisone and some additional tips which may be interest.
(NOTE: Prednisone can also have an effect on blood sugar levels, which may be of importance to diabetics).
Dr. Thomas Petty, Professor of Medicine University of Colorado Health Sciences Center; Consultant and Faculty at HealthONE Center Denver, CO.
