Steroids in Asthma and COPD

Patient Case

The team gets a call that there is a 36-year-old that present with SOB brought in by EMS and is

currently displaying increased work of breathing and in acute distress

Patient has been out of her albuterol inhaler for 7 days

The provider has asthma exacerbation at the top of the differential diagnosis

Respiratory therapy has started albuterol and ipratropium and the team asks should the team

start steroids

Should we use steroids? Which pharmacologic agent should we use? What dose should we

use?

Prednisone

Methylprednisolone

(Solu-Medrol, Depo-Medrol)

Dexamethasone

(Decadron)

Dose

PO: 40 to 80 mg/day

ORALLY in 1 or 2 divided

doses

IV/PO: 0.5 mg/kg q6h or 40 to 80

mg/day in 1 or 2 divided doses

IM: 120-240 mg x 1

IV/IM/PO: 0.5 to 9

mg/day

IV: Admin over 1 min

Formulation

Oral tablet

Oral Solution

Oral tablet

Oral Solution

IV solution

IM

Oral tablet

IV solution

IM

PK/PD

Time to Peak

~2 hours

Duration

12-36 hr

Onset:

Solu-Medrol: 0.5-2 hrs

Depo-Medrol 6-48 hrs

Duration

Depo-Medrol ~15 days

Other pearls can be found at:

https://sites.google.com/presby.edu/pharmacy-friday

What are the Benefits of Corticosteroids ?

improvement in lung function and dyspnea over the first 72 hours

What route to administer corticosteroids in Asthma/COPD Exacerbation ?

dose oral corticosteroids for the treatment of exacerbations

shown differences in the rate of improvement of lung function or in the length of

the hospital stay

What is the optimal duration of corticosteroid therapy?

Asthma: Guidelines recommend 5-10 days of therapy

COPD: GOLD guidelines recommmend no longer than 5-7 days

How to manage corticosteroids and discharged patients

Oral: Discharge with 40 to 60 mg of prednisone (or equivalent) in single daily dose

for a total of 5 to 10 days

IM: Prior to discharge administer a single depot dose of dexamethasone 10 mg,

triamcinolone diacetate 40 mg, or methylprednisolone (Depo-Medrol) 160 mg

before discharge

Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA). www.ginasthma.org

Vogelmeier CF, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report.

GOLD Executive Summary. Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582.

Walls. R, et al. (2018). Rosen’s emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.

Niewoehner DE, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of

Veterans Affairs Cooperative Study Group. N Engl J Med. 1999;340(25):1941-1947.

Micromedex [Electronic version].Greenwood Village, CO: Truven Health Analytics. Retrieved April 1, 2019, from

http://www.micromedexsolutions.com/

Walters JA,et al. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane

Database Syst Rev. 2018 Mar 19;3:CD006897. doi: 10.1002/14651858.CD006897.pub4.

Lazarus SC, et al. Clinical practice. Emergency treatment of asthma. N Engl J Med. 2010 Aug 19;363(8):755-64

Woods JA, et al. Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct

Pulmon Dis. 2014 May 3;9:421-30

Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA). www.ginasthma.org

Vogelmeier CF, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report.

GOLD Executive Summary. Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582.

Walls. R, et al. (2018). Rosen’s emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.

Niewoehner DE, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of

Veterans Affairs Cooperative Study Group. N Engl J Med. 1999;340(25):1941-1947.