Adding Systemic Corticosteroids to Inhaled Corticosteroid/Long-Acting Beta-Agonist Combinations

Introduction to Combination Therapy

The American Gastroenterological Association recommends adding systemic corticosteroids like prednisone to inhaled corticosteroid/long-acting beta-agonist combinations like Symbicort for patients with moderate to severe exacerbations that are not controlled with maintenance therapy alone 1
For patients with moderate to severe inflammatory conditions who have failed to respond to Symbicort, systemic corticosteroids like prednisone at doses of 40-60 mg/day may be necessary to induce remission, as suggested by the American Gastroenterological Association 2

The use of oral corticosteroids with inhaled corticosteroids increases the risk of systemic corticosteroid-related adverse effects, including osteoporosis and increased fracture risk, as noted by the European Association for the Study of the Liver 4, 5
The combination of oral corticosteroids with inhaled corticosteroids also increases the risk of adrenal suppression, as reported by the American Association for the Study of Liver Diseases 6, 5
The American Gastroenterological Association recommends that patients requiring both medications should consider calcium and vitamin D supplementation to mitigate bone density loss 2, 5

The American Gastroenterological Association suggests that prednisone should generally be used for short-term therapy (typically 5-10 days for acute exacerbations) to minimize adverse effects 1, 2
The European Association for the Study of the Liver recommends that if longer-term corticosteroid therapy is needed, the lowest effective dose should be used, and tapering of prednisone is typically recommended over 6-8 weeks when used for moderate to severe conditions 1
Patients on this combination should be evaluated for response to prednisone between 2-4 weeks to determine if therapy modifications are needed, as recommended by the American Gastroenterological Association 2