[Problems of indication and execution of long-term steroid therapy in advanced disabling bronchial asthma]

In the management of severe chronic asthma, extensive avoidance of known precipitating factors and optimum betastimulation supported by theophylline have pride of place. In combination with sodium cromoglycate they sufficiently relieve symptoms and lung function disturbances in most cases of adult extrinsic allergic asthma. The cases with chronic disabling intrinsic asthma need, in our experience, additional long-term use of corticosteroids. The intrinsic type (late onset, severe perennial course, aspirin intolerance, nasal polyps) is in many cases recognised only with difficulty. Detailed history-taking, reversibility of the lung function disturbances and eosinophilia in the sputum may in general differentiate it from chronic obstructive bronchitis and extrinsic asthma. The aim of the long-term use of steroids in asthma is to achieve the best effect with minimal risk. In this respect the following treatment schedule has proved its worth: daily administration of prednisone in a single morning dose, beginning with high doses of 40 to 50 mg with rapid reduction by 5 to 10 mg every 4 days to a dose of 15 mg, then gradual withdrawal in steps of 1 mg at longer and longer intervals with becotide support to achieve a daily maintenance dose of 2 to 6 mg prednisone or complete withdrawal. The response to the treatment under discussion is often excellent and the dangerous side effects are low. However, too rapid reduction of cortisone inhibits the success of this treatment plan. High doses of steroids over a long time (more than 10 mg prednisone daily), prescriptions in daily divided doses, depot administrations, self-medication, and repeated high pushes are the most common causes of the dangerous cortisone side effects and are therefore to be avoided.