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Q
I have severe asthma. I take servent, albuterol, and aerobid-4 puffs twice a day. Theodure 200 mg twice a day. Stuff for allergies - allegra and acid reflux. I find my self going up and down on prednisone. I had to take 16mg last nite and will taper for a week. As in the past, I should be clear for a week after but then start wheezing and getting tight until I have to start up the roids again. I have been taking prednisone since 1987. I think I skipped a year in 1991 but got worse when I moved to colorado. I am now back in Arizona, having some terrible steriod pain in joints and migrains and the great urge to gut someone. Am I alone?
A
First let's review your current treatment -

1. Theodure (theophylline) - a widely used bronchodilator,

2. Servent (salmeterol) - a long-acting beta2 agonist (bronchodilator),

3. Proventil (albuterol) - another beta2 agonist (bronchodilator),

4. Aerobid (flunisolide) - a locally acting steroid,

5. Prednisolone - a steroid taken orally.

Comments -
1. Theophylline is usually started at a low dose of 400 mg./day and increased by about 25% at 3-day intervals to a maximum of 13 mg./ kg. of body weight / day. ( if you're at that maximum dose you must weigh about 31 kg. or about 68 lb. - if you weigh appreciably over this you are either intolerant to larger dosage or are receiving an insufficient amount).

Incidentally, the rate of absorption varies a lot with different formulations, so that changing to a different product can result in changes in therapeutic response.

2. and 3. Both belong to the same group of so-called beta2 agonists - both are doing the same thing in the same way. I'm not sure of the rational for giving both - an appropriate dosage of salmeteral (the long-acting preparation) alone should provide the same therapeutic response as the two with greater convenience and hence better compliance. Compliance is most important and its lack is a common reason for apparent lack of effectiveness of an otherwise effective preparation and dosage.

4. and 5. Like 3. and 4. , both belong to the same steroid group and do the same thing in the same way. The compliant use of flunisolide should control your symptoms (especially when combined with those mentioned above) - you may apply up to 4 times a day for control of severe conditions. The topical application should give the best control without much, if any, systemic side-effects. Normally, additional oral steroid (eg. prednisone) would not be required.

Should an acute attack occur despite the above, prednisone may relieve the symptoms but should be continued for 2 to 4 weeks even if symptoms have been relieved.

Joint pain and migraine are not usual side-effects of steroid administration.

I feel in order to rationalize your treatment/prophylaxis plan you should consult your respirologist.

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