Asthma aid prednisone can be risky over time

ON CALL

November 23, 1993|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: During my recent flare-up of asthma, prednisone was prescribed for the first time, and no other treatment ever gave me such great relief from wheezing and other symptoms. I would like a better explanation of why my doctor stopped the prednisone so quickly, telling me that it was dangerous to continue taking prednisone for a longer time.

A: Prednisone is a drug with actions similar to those of cortisol, a steroid hormone produced by the adrenal gland. Both prednisone and cortisol can be extremely effective in the treatment of asthma, rheumatoid arthritis and a number of other disorders marked by inflammation.

Although it is safe to take cortisol, prednisone, or other synthetic adrenal steroids by mouth for a few weeks, their long-term use is limited by the potential for many serious side effects.

Unfortunately, some people with asthma may abandon other forms of treatment and rely on chronic prednisone treatment because they are so impressed with its benefits and are $H unaware of, or are too willing to risk, the dangers of its side effects.

The side effects of prednisone depend on the dose and duration of treatment, but there is great person-to-person variability. Some people tolerate large doses for a long period of time while others may develop devastating complications after taking small doses for a short period.

Osteoporosis, probably the most common and potentially the most serious complication, occurs in as many as 40 percent of those taking prednisone for a long time. A combination of diminished formation and increased breakdown of bone leads to weakened bones and loss of calcium for the body. Fractures are most common in the ribs, spine and wrist, especially in postmenopausal women already at risk for osteoporosis.

Prednisone often increases appetite with the consequent development of obesity and complications of diabetes, high triglycerides, hypertension and an increased risk of coronary heart disease.

Other common side effects of chronic prednisone use include painless muscle weakness and wasting, initially involving the thighs and shoulders; mood changes ranging from euphoria to depression; insomnia and increased susceptibility to infections; retention of fluid and loss of potassium in the urine; poor wound healing; peptic ulcers; cataracts and glaucoma.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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