A 70 year old man has reactive airways dysfunction syndrome from a previous inhalant. He was seen in 2005 for dyspnea but primary did not initiate any steroids. At that time his fev1 was 2.05, 66% predicted. When we saw him in January where there was obstruction with an FEV1 of 2.34 (72% predicted). 20 mg of steroids were given (higher doses resulted in his fingers "locking") and a repeat spiro this month shows no change in the obstruction (2.27 l, 69% predicted).
How many would continue the steroids? How many would stop the steroids for apparent lack of efficacy?
Symptomatically he has mild dyspnea with exertion that is less than prior to the steroids.
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Is the question on inhaled or systemic steroids? Has he been on an ICS?
systemic. He is already on advair during this time.
I would take him off systemic corticosteroids.
You may want to see if he has any reversibility with albuterol on your next PFT's off systemic steroids.
If it is positive (i.e. he has reversibility), you may be more inclined to escalate your RADS therapy.
Of course, everything you use is off-labe.
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