Thursday, May 12, 2005

Choice of IV steroids

People at HF give decadron for COPD and asthma exacerbations. I am used to solumedrol. Most people use solumedrol - is there an advantage of one over the other for the treatment of copd/ashtma?

6 comments - CLICK HERE to read & add your own!:

Jeff H said...

I don't think there's an advantage to one steroid over another. Most studies I've looked at use solumedrol; but I think that there has recently been a national shortage in solumedrol, and people here have needed to use decadron some. Also, maybe with all the emerging literature regarding adrenal insufficiency, people don't want to use Solumedrol because they won't be able to do a cort stim if the patient becomes hypotensive! (Actually, I doubt that has any relevence...)

Baleeiro said...

The pulmonary guys down here also use solumedrol but a lot of the primary care give decadron (IV and PO as outPt) for AECB. I agree with JCH: most of the studies are done with solumedrol but there shouldn't be a big difference.

A MD said...

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Mike L said...

The other issue is that dex does not have much mineralocorticoid effect. By giving this in sick patients, it may not give all of the "bang" you get with a more complete steroid (hydrocortisone or methyprednisolone). Most review articles imply that by giving saline and paying attention to electrolytes, aldosterone activity in the short-run is really insignficant. But, as JCH mentioned, it may be problematic in relative adrenal insuff if you forget to change.

ABetens said...
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S Long, PA-C said...

Ok, it has been 10 years since I have read Guyton, but remind me again what mineralcorticoid activity has to do with beta agonism and anti inflammatory activity which is modulated by the glucocorticoid activity not mineralcorticoid. So why would you want more mineralcorticoid activity when what your goal is cortisol action?