Patients requiring oral corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to PULMICORT RESPULES (budesonide inhalation suspension) . Initially, PULMICORT RESPULES should be used concurrently with the patient's usual maintenance dose of systemic corticosteroid. After approximately one week, gradual withdrawal of the systemic corticosteroid may be initiated by reducing the daily or alternate daily dose. Further incremental reductions may be made after an interval of one or two weeks, depending on the response of the patient. Generally, these decrements should not exceed 25% of the prednisone dose or its equivalent. A slow rate of withdrawal is strongly recommended.
As compared with continued glucocorticoid use, glucocorticoid withdrawal met the prespecified noninferiority criterion of for the upper limit of the 95% confidence interval (CI) with respect to the first moderate or severe COPD exacerbation (hazard ratio, ; 95% CI, to ). At week 18, when glucocorticoid withdrawal was complete, the adjusted mean reduction from baseline in the trough forced expiratory volume in 1 second was 38 ml greater in the glucocorticoid-withdrawal group than in the glucocorticoid-continuation group (P<); a similar between-group difference (43 ml) was seen at week 52 (P=). No change in dyspnea and minor changes in health status occurred in the glucocorticoid-withdrawal group.
Normally the adrenal glands release cortisol into the blood stream every morning. The brain monitors this amount and regulates the adrenal function. It cannot tell the difference between its own natural cortisone and that of steroid medicines. Therefore, when a person takes high doses of steroids over a long time, the brain may decrease or stop cortisol production. This is called adrenal suppression. Healthcare providers generally decrease a steroid dosage slowly to allow the adrenal gland to recover and produce cortisol at a normal level again. If you have been on steroids long-term do not stop taking them suddenly. Follow your doctor's prescription.