Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

Stopping corticosteroid therapy
In autoimmune disease, clear end-points should be set before starting therapy. Corticosteroids may improve mood and give patients a feeling of general well-being unrelated to the effect on the disease being treated. Subjective assessments can therefore be misleading. Objective clinical parameters should be used to monitor the need for continuing or restarting therapy . proteinuria in nephritis, spirometry in asthma and creatinine kinase in myositis. Therapy should be tapered off. For example, with prednis(ol)one, the dose is reduced in steps of -5 mg every 3-7 days down to 15 mg/day. At that point, switch to alternate day therapy and reduce in mg steps over 2-3 weeks. This minimises the impact on mood and lessens the drop in general well-being.

While the genetics of SLE are not very well understood, there is growing evidence for the involvement of specific genes in this complex autoimmune disease . Part of the complexity of this disease is due to the effects of both environment and genetics factors that may contribute to its development. [49] Further compounding our understanding of the etiology of the disease is the involvement of several organ systems. [50] Genetic studies of the rates of disease in families supports the genetic basis of this disease with a heritability of >66%. [51] Identical ( monozygotic ) twins were found to share susceptibility to the disease at >35% rate compared to fraternal ( dizygotic ) twins and other full siblings who only showed a 2–5% concordance in shared inheritance. [51]

The growth of children and adolescents receiving orally inhaled corticosteroids, including QVAR, should be monitored routinely (., via stadiometry). If a child or adolescent on any corticosteroid appears to have growth suppression, the possibility that he/she is particularly sensitive to this effect should be considered. The potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the risks associated with alternative therapies. To minimize the systemic effects of orally inhaled corticosteroids, including QVAR, each patient should be titrated to his/her lowest effective dose [see Dosage and Administration ( )] .

Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

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