Stopping corticosteroid therapy
In autoimmune disease, clear end-points should be set before starting therapy. Corticosteroids may improve mood and give patients a feeling of general well-being unrelated to the effect on the disease being treated. Subjective assessments can therefore be misleading. Objective clinical parameters should be used to monitor the need for continuing or restarting therapy . proteinuria in nephritis, spirometry in asthma and creatinine kinase in myositis. Therapy should be tapered off. For example, with prednis(ol)one, the dose is reduced in steps of -5 mg every 3-7 days down to 15 mg/day. At that point, switch to alternate day therapy and reduce in mg steps over 2-3 weeks. This minimises the impact on mood and lessens the drop in general well-being.
Compared to the year before the procedure, at 1-year postadenotonsillectomy follow-up, there was a % reduction in acute asthma exacerbations and a % reduction in acute status asthmaticus ( P < for both). [ 68 , 69 ] In addition, asthma-related emergency department visits were reduced by % and asthma-related hospitalizations by %. Patients who underwent the procedure also had significantly fewer refills of several asthma medications. In contrast, no significant reductions were observed in any of these outcomes among children who did not undergo adenotonsillectomy. [ 68 , 69 ]