Hello. I hope all of you, caregivers, family members & friends are well & continue to be. My Mom has been on a prednisone regimen since the week of 06/28/13. She started off with 50mg for two weeks, then (40) mg for two weeks, (30) mg for two weeks; (20)mg for (1) week & (10) mg for (1) week...she was dx'ed with radiation pneumonitis. She was on a smaller course of predisone in early May and her cough and phlegm was almost gone and then completely gone for a very brief period of time and then came back. Our doctors referred her to a pulmnologist which prescribed the most recent regimen after giving her a battery of breating tests. Well... her cough and phlegm issue is somewhat better but still not as good as what it was in the middle of the first steriod regimen in May. Anyway..she is not yet clear of the coughing and phlegm issues...could the effects of the radiation pnemonitis last this long and still require more steriods? Also just this past week my Mom has been experiencing lower BP readings that she has not been accustomed to...definitely lower for her. Can this much steriod use be affecting her cardiovascular system to cause her to have low blood pressure and still have a hear rate in the mid 90's? The heart rate is not always in the mid-90's only during exertion...usually the resting heart rate is from 70 to 82 bpm. Or could these effects be coming/caused by other issues and or a combination of issues? We have emailed/called her pulmnologist this past week and he has not responded yet? Her pulsox readings so far have been in the high 90's & her CT'S /PET/CT's have been very good so far and hope obviously they continue and I sincerely hope for everyone! She had/has adeno stage3A. She had finished treatment early Dec. 2012. Please let us know what you think and thank you very much.
Prednisone use - 1258407
dkm5859
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Reply # - August 2, 2013, 10:07 PM
Reply To: Prednisone use
Unfortunately, it can take a very long time for radiation pneumonitis to resolve, and sometimes it doesn't resolve completely. It's not uncommon for people to need a higher dose of steroids again after a taper.
Here is a link with several pages that summarize key issues about radiation pneumonitis, including the central theme that steroids are the main treatment:
http://cancergrace.org/search-results?q=radiation%20pneumonitis
There are many issues that can impact heart rate and lung function, so I think it'll be necessary to work with her doctor(s) about the possible issues and how to best address them.
-Dr. West
Reply # - August 29, 2013, 02:01 PM
Reply To: Prednisone use
Hello again...revisiting the same topic again which is this thread...
My Mom is completing/tapering down her latest which is her second prednisone regimen. Her first was about three weeks starting in early May..her cough and spitting went basically completely away and then came back about a week later. She started a second regimen for (8) weeks which started in late June. Now..she is starting to experience more coughing again... she is gaining weight quite well and is slowly getting better with most performace status factors but she does still have issues. She did see her pulmonolgist on 08/23/13. He stated to continue (10) mg of prednisone a day for two more weeks. She has her (3) month CT check-up on 09/09/13 and appointments the same day with care team.
So...here goes..is this likely her radiation pneumonitis still hanging around and if so what if anything more than just sterioids can be done to combat and or hopefully eliminate this? Her second taper schedule was (60) mg per day for two weeks, then (50)mg per day for two week, then (40) mg per day for (1) week and (30) mg per day for one week and so forth for eight total weeks. Please let me know what you think if you will offer some advice and or information . Thank you very much in advance.
Reply # - August 29, 2013, 03:49 PM
Reply To: Prednisone use
Hi dkm, I'm sorry your mom is still dealing with this cough. I don't know if you've seen this but it's a blog post by our Dr. Pinder about managing coughs.
http://cancergrace.org/cancer-treatments/2009/05/09/managing-cough/
Dr. West had this to say about the variability of how long a cough may last from pneumonitis, "In truth, the results are quite variable in terms of how readily the cough reverses with time +/- steroids. In some cases, it resolves in a few weeks, while in others it can take months to resolve, and sometimes people continue to have a residual, very chronic cough (though thankfully that happens relatively rarely)." http://cancergrace.org/topic/radiation-pneumonitis-cough
On a personal note I had pertussis a couple of years ago that was from what I understand quite a bad case for an adult. I couldn't sleep because of the coughing fits and had to run to the bathroom when a coughing attack started to get away from others. I understand now how a baby couldn't handle such a cough. I had to create a plan of action just to be able to breathe during it. so...I asked my doctor for a prescription for opiate cough syrup. The results were immediate and I wonder if the opiate wouldn't be an easier drug to handle in your mom's situation.
I'll let you read this and respond with follow up questions before I contact a doctor for comment.
I hope you and your mom are feeling alright otherwise.
Janine
Reply # - August 29, 2013, 09:58 PM
Reply To: Prednisone use
Janine did a great job unearthing my prior comments, which still characterize my interpretation. Steroids and time are the main treatment, and they often work, at least partially, but the timetable varies widely from person to person, and it's not rare for people to have only incomplete improvement over a long time. Some people require chronic steroids.
Good luck.
-Dr. West
Reply # - August 30, 2013, 07:56 AM
Reply To: Prednisone use
I would imagine prolonged and or large doses of prednisone can cause the serious side effects associated with their use in any person and I imagine they vary on a case by case basis...I guess my follow-up is...what is considered on average to be prolonged and or too much usage of steriods where serious side effects would/could commence? Thank you very much to everyone. I will mention the opiate cough syrup.,thanks Janine.
Reply # - August 30, 2013, 10:27 PM
Reply To: Prednisone use
Anything getting into the range of months is becoming concerning. However, it's just a continuum. There isn't a magic dose or duration that crosses a threshold.
-Dr. West