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Corticosteroids Medicines and Drugs

In Bronchial Asthma: Corticosteroids are not normally used in acute or chronic cases of bronchial asthma which can be brought under moderate control by other drug. However, in cases of status asthmaticus (uncontrollable acute severe asthma) intravenous soluble steroids are needed in addition to bronchodilating drugs.

These can be withdrawn when emergency is over and replaced by inhaled drugs such as beclomethasone dipropionate (50-1 00 ug/puff-Beclate Inhaler), Budesonide (Pulmicort Inhaler), or Fluticasone propionate (Flohale Inhaler). In chronic bronchial asthma, corticosteroid therapy may be considered when all other measures have failed. In such cases the aim of the therapy is to give corticosteroids on alternate days or to keep the dosage low enough to reduce the symptoms partially. The patient is encouraged to take the usual medicines along with corticosteroids in order to keep the dose of the latter at the minimum level. For this reason a short-acting corticosteroid such as prednisolone is preferred to the long-acting betamethasone or dexamethasone. Inhaled drugs are preferred in this situation.

In Diseases of the Eye: Corticosteroids ointment or drops are very useful in inflammatory conditions of the eye. They reduce pain, redness, and secretions of the eye caused by the inflammatory process and provide remarkable relief. However, they should not be used in the treatment of mechanical laceration or abrasions of the eye because of the risk of delay in healing and promotion of the spread of infection. Likewise, these should never be used in bacterial, fungal, or viral infections of the eye as the symptoms of the progression of the disease may be masked until sight is lost. Corticosteroids should never be used in herpes karatitis, as an irreversible clouding of cornea may occur because of the progression of the disease. Corticosteroids also increase the pressure of the fluids in the eye (intraocular pressure) in some cases and if the pressure is already high, a painful and disabling condition called Glaucoma may be precipitated.

It is quite depressing to note that a large number of eye drops and ointments available in India contain a combination of these drugs with antibiotics for the treatment of inflammatory conditions of the eye. Such combinations are no more effective than the corticosteroids alone. They only add to the cost of the medicine. It is advisable to use an antibiotic separately in case of bacterial infection and corticosteroid alone for inflammation. When given in combination, these prolong the infective state. Oral or ocular injections are needed in the treatment of opticneuritis to save eye-sight.

In Skin Diseases: Preparations of corticosteroids, like ointments, creams, and pastes, are often used for various skin disorders. These do provide dramatic relief, but unfortunately the effect does not last too long. An important use of corticosteroids is in eczema in which hydrocortisone ointment is usually applied. Pemphigus* is another very important condition in which it is life­ saving, where large doses of prednisolone, ranging from 40 to 120 mg per day, are required to be given orally.

In Shocks: Corticosteroids are often administered in septicemic shock as a desperate attempt to save life. There are many other conditions in which steroids have role to playas palliative drugs. In brain oedema due to tuberculosis and infections, intravenous dexamethasone is some times life-saving. Similarly, in injury to backbone large doses prevent paralysis. Steroids are essential compount of combined chemotherapy of blood cancers (acute leukaemia) and lymphomas. They are also useful in brest carcinoma and also useful in breast carcinoma and also prevent rise in blood calcium levels in advanced cancers. High doses are given to prevent graft rejection (skin and kidney) in organ transplantation.

Steroid enema is useful in ulcerative colitis. They prevent lung damage in aspiration pneumonia and occurrence of respiratory distress in premature newborn. For this purpose they are given to mother to late pregnancy.

Precocious sexual development in female with male feature occurs due to enzyme deficiency in their adrenal glands and its over-activity. This can be checked by giving hydrocortisone.

Adverse Effects: Corticosteroids are known to cause a number of adverse effects, depending upon the dosage and the duration of treatment. A short-term treatment may not pose any problem but when used for a longer time (more than 2 to 3 weeks) three types of problems are known to occur:

Adverse effects of glucocorticoidsFree Reprint Articles,

Suppression of pituitary control on adrenal gland and

Adverse effects due to sudden stoppage of them.

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