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Ask the Allergist: What Is Considered a High Dose of Steroids for Asthma Treatment?

 

Information from AAFA’s Ask the Allergist is not a substitute for a consultation with a health care professional. Always talk with your own doctor before making changes to your asthma or allergy management plan.

This question appeared in our spring/summer 2020 issue of freshAAIR Magazine, our FREE digital magazine featuring news and resources on asthma and allergies. Read the most recent issue.


Question: When using oral steroids daily for the treatment of asthma, what is considered a “high dose”?

Answer: Oral steroids are not an ideal treatment of asthma and should be used only as a last resort. The new biologic medicines given by injection or IV do not contain steroids. They have been shown to reduce the need for oral steroids for people with certain types of severe persistent asthma. The side effects of oral steroids depend on both dose and how long you take the medicines. So even low doses can lead to significant side effects over time. The term “high dose” is relative. It means something different to different people. The good news is that fewer people will need daily steroids as asthma medicine options continue to improve.


Dr. Douglas Johnston is our Ask the Allergist columnist. Dr. Johnston is a board-certified allergist/immunologist with Asthma & Allergy Specialists, P.A., in Charlotte, North Carolina. He obtained his D.O. from New York Institute of Technology College of Osteopathic Medicine. He completed his residency at Winthrop University Hospital in Mineola, New York. Dr. Johnston grew up with both allergies and asthma. He decided it would be exciting to help people with these conditions. His passion about food allergies also comes from having a child with a peanut allergy. 


“AAFA’s Ask the Allergist” is a free service provided by the Asthma and Allergy Foundation of America (AAFA). Our allergist will answer your questions about managing asthma or allergies and medicines and treatments. Submit your question on our website.

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Shea - thanks for sharing your thoughts. You bring up a good point that biologics are not accessible to everyone because of cost which often depends on the type of insurance coverage. Access to medicine is one of AAFA's key advocacy issues.

StephM - this question was not a recent question, so not related to COVID-19. You do raise a good question. The data about COVID-19 and risk factors is still developing and we are keeping a close eye on things that impact people with asthma so we can add when we get more info.

So, one thing being covered in the media/public health guidelines is "high dose corticosteroids" being a risk factor for developing more severe covid19.  I suspect the questioner may have been inquiring about that.  Perhaps adding an addendum might provide that context.

These new biologics are expensive-- even with insurance the out of pocket costs make them unaffordable to me. That might change with time. I know there are some programs out there that help people, but in my current situation none help me.

I am also curious if people are able to stop them without needing to go back on them or oral steroids, or if they need to continue them indefinitely.

I also worry about any new medications long-term risks, like for cancers. Some of that is hard to know until people have been taking them for many years.

I have a severe chronic allergic disease which asthma is one component, and prednisone is more commonly used to control than for asthma alone, and I know prednisone has its risks.. But it has been around a long time and doesn't have huge cancer risks and it is not expensive. It works and its results are pretty immediate and strong. It helps me so much on a daily maintenance dose, as weaning lower than 20mgs has caused big flare ups and made my condition impossible. I would like to get to 10mgs eventually because have heard the side effects are less at that dose. Right now I have the cushings syndrome with a puffy face and weight gain and posture issues being the most visible but also have acid reflux, glaucoma, and osteopenia. So it obviously isn't ideal but it really is the only good option for me right now.

My hopes are...I have learned a lot about allergic and asthma triggers since being diagnosed with churg-strauss syndrome 8 years ago, so I hope my increased knowledge and subsequent lifestyle changes might help me to wean lower (as they have helped me stabilize on this dose).

Weaning off prednisone is harder than most give credit to. At least for me. My plan is to try the wean during my best time of year when allergic and asthma triggers are at their lowest. I try to plan a lot of rest during that time, as after long term use it causes a lot of stress for the body to adjust, a lot of fatigue, and a return of symptoms that I can only hope my body will be able to handle. It will be a slow wean over a long amount of time and each lowering will be contingent on how my body us handling it and what my symptoms are. And I am trying to wait for the pandemic now to be over, because I need my stuff under control with it being here so predominantly in my state especially, I need my full strength and to avoid hospitals right now. 

Last edited by Shea
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