Asthma Not Responding to Prednisone: Meaning and Treatment

If your asthma symptoms are not responding to prednisone medications, it may mean your medication plan needs updating. Other times, it can be a sign of steroid-resistant asthma.

Prednisone (Cortan, Deltasone, Rayos) is a type of steroid medication that can be used for asthma flare-ups or attacks.

Not having any symptom improvement after taking prednisone may mean that your treatment plan needs improving or that you have steroid-resistant asthma.

If you are still wheezing after taking prednisone, or have other asthma symptoms, contact a doctor immediately for advice.

This article discusses what it means and what to do if asthma is not responding to prednisone or is steroid resistance. It also discusses alternative treatment options to consider.

There are a few different explanations for asthma symptoms not improving with prednisone or other prescribed steroid medications:

• Your asthma has the potential to respond to prednisone, but:
  • your prescribed dosage may need adjusting
  • you may not be taking the medication correctly
• Prednisone is not effective for you, but other similar medications may help.
• You have steroid-resistant asthma.

To work effectively, you may need to take it several days after an asthma flare-up. If the prednisone works, your asthma symptoms should respond or begin to improve during this time.

Alternative steroid medications that may help manage asthma include:

• cortisone
• betamethasone (Betnesol, Vistamethasone)
• dexamethasone (Decadron, Dexasone, Baycadron, Solurex)
• prednisolone (Pediapred, Flo-Pred, Millipred)
• methylprednisolone (Medrol, Methylpred-DP)

However, if your asthma is not responding to prednisone, it may not respond well to other steroid medications. This is known as steroid-resistant or steroid-unresponsive severe asthma.

Severe asthma is when asthma symptoms are difficult to manage, even with high doses of medications.

There are many different types of severe asthma, including asthma that is resistant to steroids such as prednisone.

Asthma is an inflammatory condition that causes the airways to swell, constrict, and produce excess mucus. Steroids, due to their anti-inflammatory properties, can effectively treat asthma in many cases. Yet for a small group of people, either steroids do not work well enough, or a very high dose is needed to manage symptoms.

Researchers continue to investigate the biology of asthma and what may cause steroid resistance. For people with severe asthma, some experts suggest different processes occur within the body to cause it to become resistant to steroids, from genetics to the way the cells communicate.

Steroid-resistant severe asthma can be challenging to manage completely. Still, progress has been made in its treatment. As a result, there are specialized treatment options for steroid-resistant severe asthma that may still help.

Treatment options for steroid-resistant severe asthma include:

• Controller medications: Controller medications are taken long term to help prevent and manage asthma symptoms. Controller medications your doctor may recommend for steroid-resistant asthma include:
  • long-acting beta 2 agonists
  • montelukast
  • theophylline
• Macrolide antibiotics: The short-term use of macrolide antibiotics may help treat infection and avoid triggering asthma symptoms. They are not appropriate for long-term use.
• Biologic medications: Also known as monoclonal antibodies, biologic medications target immune cells to help stop the inflammatory response to asthma triggers.
• Bronchial thermoplasty: Bronchial thermoplasty is a minimally invasive procedure that applies heat to the airway walls. This may reduce the amount of smooth muscle tissue, decreasing the constriction of the airway and asthma flare-ups.
• Lifestyle approaches: Lifestyle approaches may help you avoid triggering further asthma flare-ups. For example, try keeping a diary of your symptoms and activities to identify and avoid potential triggers. Managing any other conditions you have by following your doctor’s advice and having regular checkups may also help.

In some cases, your medical team may suggest continuing to take some steroid medications as part of your treatment routine.

Read more about asthma treatments, including trigger avoidance and breathing exercises.

If you have asthma symptoms that are not improving with prednisone or your prescribed medication, call 911 or your local emergency services. Flare-ups or asthma attacks that are not manageable with your usual medication may require emergency or hospital treatment, known as acute treatment.

After receiving any necessary treatment, talk with your doctor to review your current treatment plan. If necessary, they can adjust your medication dosage, advise you on how to use each one, or try new treatments.

You can also work with a doctor to create an asthma action plan, which will provide tailored advice on:

• when to contact your doctor or call 911
• what to do in the event of symptom flare-ups, such as what treatment to take when
• how to monitor your symptoms
• how to take your treatment, including any maintenance or controller medications

Learn more about making and using asthma action plans.

In some cases, asthma not responding well to prednisone or other steroids may be due to a need to adjust your dosage or review how to take them with a doctor.

However, still having symptoms after taking prednisone and other steroids can also indicate steroid-resistant severe asthma.

Steroid-resistant severe asthma can be challenging to manage completely, but effective treatment options can include controller medications, biologic medications, and bronchial thermoplasty.

Call 911 for any symptoms that do not improve with your prescribed treatment, such as if you are still wheezing after taking prednisone. Also, contact a doctor to review your treatment plan and make any needed adjustments.