Some Doctors Do Not Know How to Read (More on Scary Steroids)

[McCamy Taylor]

Was told today by the same urgent care that has prescribed short courses of steroids for my asthma for years that they no longer use oral steroids to treat asthma exacerbation. Because of COVID.

WTF!

Here is the WHO position paper that is causing all the controversy. Note that the paper says do not give steroids routinely for COVID due to lack of proven efficacy and possible (not proven) harm.

https://apps.who.int/iris/bitstream/handle/10665/331446/WHO-2019-nCoV-clinical-2020.4-eng.pdf

Some doctors are treating this as dogma. An 11th Commandment. Thou Shalt Not prescribe Oral Steroids for Anyone in a COVID Pandemic. If they would just read the fine print they would see that the WHO also says

Given the lack of effectiveness and possible harm, routine corticosteroids
should be avoided unless they are indicated for another reason. Other reasons may include exacerbation of asthma or COPD,
septic shock, and risk and benefit analysis needs to be conducted for individual patients.

See that, Urgent Care! Asthma is still considered a reason for Prednisone. Unless you own a chain of hospitals and want to put all the asthmatics into them. Early short course steroids have been proven to improve asthma and cut down the risk of hospitalization. If you wait too long , then it takes even longer for the asthma to get better.


Here is the American Academy of Allergy Asthma and Immunology weighing in:

There have been several reports that steroids are contraindicated in COVID-19 disease, so many are wondering what should people with asthma do if their controller medication is a steroid (inhaled or oral). The short answer is continue taking your controller medications and do not stop them. The data suggesting that steroids might increase the shedding of SARS-CoV-2 comes from treating hospitalized patients with systemic steroids just for the viral illness. The use of steroids for treating other diseases (like asthma) was not studied. However, people with asthma are placed on controller medications to keep their asthma under control. In the current pandemic, the best thing a person with asthma can do (with respect to asthma) is to get and keep their asthma under control. Stopping a controller medication will put the person at risk for developing an asthma exacerbation—especially as we enter spring allergy season. In the current pandemic, treatment of an exacerbation will likely require going to the emergency department or urgent care, where the individual has a much higher risk of being exposed to someone with COVID-19. So, in a way, by continuing to keep asthma under control, the person with asthma is actually reducing their chance of exposure to COVID-19.

https://www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma

I was able to avoid the ER. I went to another Urgent Care, luckily a doctor I knew was working and I scored some Prednisone (gasp!) along with inhalers.

It is a hard, cruel world out there right now for asthmatics and COPDers.

[dhol82]

1. Damn, I feel grateful that I haven't had any major exacerbations lately.

Still a little ancy since I had pneumonia in December. Totally non descript symptoms and not diagnosed until I got a chest X-ray.
Scary shit!

[JCMach1]

2. Glad I fixed my Gout attack before this mess

[underpants]

3. I just got a Prednisone scrip on Friday for my gout

Longest attack ever. Two weeks. Treating with cherry juice vinegar turmeric nice and heat. Finally I called a telehealth Friday afternoon and got colchicine and prednisone. Haven't taken the prednisone yet but the colchicine worked fast. I should be running again by Wednesday.

[JCMach1]

5. Same got prednisone from teladoc when I woke Sunday

Two weeks back with the signs. I did not want to get to the ER point. Prednisone, radical diet change and threw while anti-inflammatory kitchen sink at it. Irony, I think I did it to myself by talking fish oil supplements without thinking.

[underpants]

6. Damn I took fish oil at one point

Yeah I've decided to get the most of this time "off" (still teleworking) dropped booze two weeks ago, quit smoking today - had a couple this morning but now I'm out, working out (lost 5 pounds already), picked up the guitar again, and am going to put in 30 Minutes a day on Spanish. This is a once in a lifetime (god I hope) opportunity and I'm not wasting it. It's time everyone did a health wake up check AND chill relax enjoy this and hope no one you know dies. I told my family over the weekend that I'm in "beach mode". Everything is cool. No problems.

[Meowmee]

4. Crazy- asthmatics with chest involvement do need oral steroids

For my dad he needs it when he is bad. He has a doc who understands that and he has plenty on hand all the time as well as, enough for me too if I need it which is rarely. I was on them for a while years ago for a bad bronchitis as well as antibiotics and my inhalers.