Wednesday, May 14, 2008

Corticosteroids (Prednisone)

Corticosteroids are often prescribed to cystic fibrosis patients as a way to decrease inflammation in the body. When given in an initially large (sometimes called a “burst”) then tapering dose, corticosteroids such as prednisone have been shown to be effective in dealing with the short-term inflammation problems caused by asthma and allergies. Corticosteroids, specifically forms of fluticosone, are also commonly used as a treatment for allergic bronchopulmonary aspergilliosis (ABPA.)

Cystic fibrosis patients who culture P. Aeruginosa infection have demonstrated an increase in their forced vital capacity (FVC, i. e., the total amount of air they’re able to breathe in at once) measure on part of their pulmonary function tests.

Long term use of corticosteroids must be monitored carefully. When the body is relying on corticosteroids for a long period of time, it ceases production of its own steroids. In some cases, cystic fibrosis patients may become fully dependent on a course of corticosteroids just so their bodies can function properly in response to natural biological stressors such as illness or injury.

The most documented complication of long term or high dose treatment using corticosteroids is their ability to induce diabetes mellitus or cystic fibrosis related diabetes. Prolonged use of prednisone can weaken the skeletal system and can cause growth problems, osteoporosis and adrenal suppression. These side-effects are even more devastating in younger patients with cystic fibrosis. Side effects of prednisone include insomnia, elevated mood, and in some cases, even mania. Using prednisone for long periods can cause side effects such as puffy face (called ‘moon face’) weight gain, osteoporosis, glaucoma and type II diabetes mellitus. Stopping the medication without tapering down the dose may cause some patients to suffer from depression.

Inhaled steroids such as Flovent, Azmacort, or Pulmicort have been effective in their long term use for controlling the inflammatory effects of asthma. These inhalers do not provide immediate relief of symptoms like a bronchodilator would, but when used as part of a regular treatment regimen they can help keep wheezing and chest tightness under control. Because the benefits of oral corticosteroids are apparent, current studies have turned to the efficacy of inhaled corticosteroids on lung function in individuals with CF. A pilot study examined inhaled corticosteroids over a 30-day period and concluded that patients treated with inhaled steroids had better pulmonary function. Inhaled delivery of corticosteroids has far fewer adverse effects than other forms of the medication.

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