Glucocorticoids, in particular, Prednisone, in the treatment of allergic diseases are widely used as substitution therapy (for glucocorticoid dependence), as inducers of remission (with serum sickness), as pulse therapy (in high doses for asthmatic status, anaphylactic shock), in the form of basic therapy (modern inhaled glucocorticoids in bronchial asthma).However, the use of glucocorticoids is every time a desperate, compulsory measure that requires an in-depth analysis of the disease, a prognosis, a correct evaluation of the real efficacy of non-glucocorticoid therapy, and, most importantly, the identification of measures that help prevent the effects of hormonal drugs.
Glucocorticoids are biologically very active part of hormonal homeostasis, in the production and self-regulation of which the main role is assigned to the pituitary-adrenal system. In the adrenal cortex, cortisone is synthesized. It is a biologically inactive compound, which in the liver turns into an active – hydrocortisone (cortisol). In an adult, 10-30 mg of cortisol is produced per day, under stress (various overloads, injuries, infections, etc.) this amount can increase 10-fold (up to 250 mg). The need for an organism in cortisol is uneven during the day and depends on the activation of metabolic-enzymatic processes – most of it is realized in the daytime (especially in the morning and in the middle of the day) period and only 1/10 – at night. Assigning glucocorticoid drugs, which are easy to buy in pharmacies, it is necessary every time to make efforts to avoid possible unwanted reactions.
The appearance of unwanted reactions is associated with the duration of glucocorticoid therapy, predisposition to them, the presence of risk factors – hypertension, gastric ulcer, excessive body weight, osteoporosis. By the time of development, they can be early or late.
Therapy with glucocorticoids is divided into substitutive and anti-inflammatory. Substitution therapy replenishes the missing endogenous cortisol against a background of adrenocortical insufficiency. The drug of choice for this therapy is hydrocortisone, the drug closest to cortisol. Among the undesirable reactions with long-term therapy with glucocorticoids, secondary adrenal insufficiency deserves attention.
Anti-inflammatory therapy can be performed in different regimens as initiating (remission induction), long-term, alternative, pulse-therapy, antiemetic therapy, inhalation long-term therapy.
The anti-inflammatory effect of glucocorticoids is due to a number of factors.
In patients with bronchial asthma, a 4 mg dose of oral glucocorticoids is possible in one week, with the transition to the regimen of inhaled glucocorticoids.
To avoid systemic effects of glucocorticoids, where possible, preference is given to their local use and preparations that can be absorbed in minimal amounts.