What is your usual practice regarding inhaled steroids when you admit a patient for either status asthmaticus or AECB?
If they are already on an ICS on admission and they will be on a systemic steroid do you continue the ICS?
Conversely, if they are not on an ICS on admission and are now on a systemic steroid, do you start an ICS during the admission or after D/C?
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I start them during the admission, or continue them throughout the hospitalization while they are on systemic CS.
I've never seen any data, but there are theoretical benefits to inhaled delivery of CS in these settings, and it's hard to see how there can be harm to using them in that setting.
Great question. I have searched the literature for an answer. I leave them on inhaled steroid in house (minus the longacting b-agonist) and start inhaled steroid on admission. It takes a few days to weeks for the inhalked steroid to reach full effect and the effect may be attained through slightly different mechanisms (theoretically) than systemic steroids.
The second anonymous comment is my rationale for starting ICS in house. First, I often will neglect to add them on discharge and, when the patient is tapered off systemic CS, they have no steroids on-board.
There are some theories that systemic CS do not get in the alveolar lining fluid in the doses that ICS do, so that is one theoretical benefit (i.e. getting the medicine to the alveolar epithelial cells).
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