Thursday, October 6, 2016

1970s: Steroids for Asthma: Part II


By the 1970s, most drugs that contained cortisol were called corticosteroids, or glucocorticosteroids, or simply steroids. They were mainly prescribed in low doses to end severe asthma episodes, and usually in conjunction with epinephrine, or a longer acting version of epinephrine called susphrine.

And then you were gradually weaned off of them over the course of about a week. This allowed your adrenal cortex time to start gradually producing its own cortisol in order to prevent the risk of sudden onset symptoms that occur when cortisol production is shut off, which includes the risk of dying a sudden death.

Steroids were only used when the short term benefits were determined to outweigh any risks of long term side effects. One such circumstance would be if a physician believed the risk of dying from an asthma attack remained high despite aggressive treatment with the bronchodilators such epinephrine or Isuprel, plus the intravenous application of aminophylline, then the option left on the table intramuscular steroids.

It usually took about an hour for steroids to start working. One doctor explained to me a few years back that this was the reason susphrine became so popular among emergency room physicians. He said an asthmatic would come to the emergency room struggling to breathe, and would be given an intramuscular injection of susprine.

Susphrine was a long acting version of epinephrine that lasted several hours as opposed to just a few. He said it was well liked because it would be given at the same time as an intramuscular steroid. The susphrine would open airways within five minutes, and would last long enough for the steroid to take effect.

He said this was nice because it allowed emergency room physicians to send patients home knowing that they would be breathing easy long enough for the steroid to start working. It was a nice combination of medicine.

I know, because I was given these two medicines nearly every time I entered an emergency room for severe asthma. I remember I'd come into the ER, and I would be given an Alupent breathing treatment. I knew the treatment wasn't going to do any good, but remember politely puffing it while the nurse, respiratory therapist, and doctor waited to see if it would work. But all along I would just wait for the shot -- the susphrine shot.

I didn't know this at the time, so the susprine was the only medicine I looked forward to. I would watch the clock, while clutching the edge of the bed with my shoulders high working hard to suck in air, knowing that at the five minute mark I'd be able to take in a deep breath. Oh, what relief that felt like, to finally be able to take in a deep breath after suffering for so long. Lord knows I would never tell my parents to take me to the ER until after I had suffered long and hard, and knew that it wasn't just in my head.

So really, while I thought it was the susphrine that was helping me, it was the combination of both the epinephrine product and the steroid product. One opened my airways short term, and one kept them open long term.

I remember having asthma attacks at home, and mom would walk me to the bathroom, where a medicine that helped me breathe better was kept in the medicine cabinet. I remember it tasted horrible, which makes me think it was probably a steroid solution.

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