I am Carmen from Queensland, Australia, have always been a bit unfit, but after a motor vehicle accident 5 years ago where I was in bed, for 3 months, have now been diagnosed with severe Emphysema, however I have also had Crohns Disease, taking a lot of Prednisone 20 years ago, play Lawn bowls and have shocking thin bruising, tearing thin skin, that becomes easily infected, also have just found out I have Kidney disease with shrunken kidneys and cysts, so am not having much meat and have cut out salt, I have also read that Kidney disease can cause breathlessness, I can put up with everything else I have except the severe breathlessness. I have a burning throat all the time and severe heartburn.
During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every 6 hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenocortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, Prednisone, and prednisolone, are considered to be short acting (producing adrenocortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.
Continuing with the acute bronchitis case, this patient would usually be given a short term steroid “burst” of high dose prednisone. Those high daily dose is usually tapered off over the course of a few days to avoid adrenal exhaustion and withdrawal effects. You see, when you introduce prednisone (which the body recognizes as cortisol) to the body, the adrenals stop making their own supply. The theory behind tapering off of steroids like prednisone is that by slowly removing the external steroid source, the body can adapt and begin making its own again with less stress placed on the system. The practice of tapering in short term therapy, even in higher doses is debated by many clinicians. Some doctors and clinicians claim that not only is a taper not necessary in short term therapy (14 days or less) but it is better to stop this therapy earlier, the adrenals and body adjust just fine. Using a taper just introduces more of the artificial source for a longer period of time, which is best to be avoided to minimize side effects and more quickly restore natural body hormone levels.