A systematic review of RCTs of ICS vs. non-ICS therapy for COPD showed an increased risk of TB associated with ICS use (Peto OR, ; 95% CI -), and no excess risk of influenza with ICS use (Peto OR, ; 95% CI -) ( Dong 2014 ) [evidence level I]. The risk for TB was higher in endemic areas (NNH 909), compared to non-endemic areas (NNH 1,667). Limitations of the systematic review included: these outcomes were not the primary outcomes; limited number of trials reporting TB events; lack of chest x-ray at recruitment; varying definitions for TB infection; and differential withdrawal rate between ICS and non-ICS groups; and the authors recommended further investigation ( Dong 2014).
Just as taking prednisone can cause side effects, reducing the dose may cause problems as well. Prednisone is not addicting like a narcotic, but many patients experience withdrawal symptoms as the dose is reduced. These often include muscle soreness, joint pain, fatigue, and depression. Know that these effects are also temporary and worth bearing to allow a cutback in your dose. If you experience any unusual symptoms as your prednisone dose is reduced, contact your doctor. It may be necessary to temporarily increase your steroid dose until you are feeling better and then taper the dose more slowly.
Eleven trials involving 2301 people were included: six in adults, two in neonates, three in children. All but one examined use of steroids for the prevention of post- extubation stridor ; the remaining one concerned treatment of existing post- extubation stridor in children. Patients were drawn from heterogeneous medical/surgical populations. Dexamethasone given intravenously at least once prior to extubation was the most common steroid regimen utilized (uniformly in neonates and children). In neonates the two studies found heterogeneous results, with no overall statistically significant reduction in post extubation stridor ( RR ; 95% CI to ). One of these studies was on high- risk patients treated with multiple doses of steroids around the time of extubation , and this study showed a significant reduction in stridor . In children, the two studies were clinically heterogeneous. One study included children with underlying airway abnormalities and the other excluded this group. Prophylactic corticosteroids tended to reduce reintubation and significantly reduced post- extubation stridor in the study that included children with underlying airway abnormalities (N = 62) but not in the study that excluded these children (N = 153). In six adult studies (total N = 1953), the use of prophylactic corticosteroid administration did not significantly reduce the risk of re- intubation ( RR ; 95% CI to ). While there was a significant reduction in the incidence of post extubation stridor ( RR ; 95% CI to ), there was significant heterogeneity (I 2 =81%, X 2 =, df=5, p<). Subgroup analysis revealed that post extubation stridor could be reduced in adults with a high likelihood of post extubation stridor when corticosteroids were administered as multiple doses begun 12-24 hours prior to extubation compared to single doses closer to extubation ; the test for interaction for multiple versus single doses indicated RRR (95% CI to ) for stridor with multiple doses. Side effects were uncommon and could not be aggregated.