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Cortisone - Benefits, Needs, and Side Effects

19.05.2017

What are the benefits of cortisone?
This is a hormone that the body produces itself in the adrenal gland. It is mainly formed in stressful situations, but it also regulates the immune system and can reduce excessive inflammatory reactions. Cortisone causes the bronchial mucosa to swell, reduces mucus production, inhibits the allergic reaction and reduces the hypersensitivity (hyperreactivity) of the bronchi. While cortisone tablets can have serious side effects depending on the length of time they are taken and the dose, the inhalation of modern cortisone sprays is also unproblematic in long-term use, even if the opposite is repeatedly claimed in the media.
and how to prevent unwanted side effects, Dr. med. Urte Sommerwerck, Senior Consultant in Charge at the Pneumology Clinic
Respiratory and pulmonary medicine (pulmonology) is a branch of internal medicine that deals with the prevention, detection and specialist treatment of diseases of the lungs, bronchi, mediastinum (middle skin) and pleura (pleura and lung).
, Allergology, sleep and respiratory medicine at the Helios-Klinikum Wuppertal, in their lecture at the 10th Lung Symposium on September 2, 2017.

Cortisone has many tasks in the body: It mobilizes energy reserves and causes the breakdown of protein. This leads to an increase in blood sugar and a release of fat. Cortisone ensures the cardiovascular function and controls the water electrolyte balance. Cell division is slowed down and immunological and allergic processes are generally suppressed.

Therapy with cortisone can be very beneficial in the case of vomiting caused by cancer therapy agents. Even with metastases caused by metastases
Daughter tumors spreading from cancer
Conditional cerebral edema unfolds a great effect. In principle, all inflammatory diseases in the body can be treated with cortisone. These include B. rheumatism, inflammatory bowel disease, liver or kidney inflammation, multiple sclerosis, multiple sclerosis
Multiple sclerosis, MS for short, is a progressive, chronic disease of the nerve cells in the brain and spinal cord. The marrow, a fatty layer that envelops the nerve fibers, is lost (demyelination). These demyelinated areas can vary in size - from the size of the tip of a needle to that of a pea or larger. The symptoms can vary in severity and depend on the location of the damage. Visual disturbances, bladder and rectal disorders, coordination disorders, unsteady gait and paralysis up to being confined to bed can be the consequences. In the meantime, the symptoms recede (remission) until the disease flares up again. Some patients live ten to fifteen years after the onset of the disease, others have longer lasting remissions (during which they feel better and which can last up to 25 years) and thus reach a normal life span.
or vascular inflammation. In the lung area, the use of cortisone is particularly common in bronchial asthma or COPD. After a lung transplant, immunosuppression without cortisone is unthinkable. However, cortisone cannot cure a disease, it only improves the current situation of a disease. After the inflammation or symptoms have subsided, therapy with other drugs must be continued.

The effect of externally applied cortisone only sets in 15 minutes to a few days after ingestion, because cortisone is a hormone that activates various processes in the body. As a rule, 8-25 mg of cortisol are released from the adrenal cortex (adrenal cortex) per day, up to 300 mg during stress. The hormonal control takes place via a control circuit of the NNR with the hypothalamus in the brain and the pituitary gland. With external cortisone supply, this control loop is suppressed and the body cannot immediately make the body's own cortisol available again in sufficient quantities. Therefore, if cortisone is used for longer periods of more than 5-10 mg / day, the dose should only be reduced very slowly (so-called tapering). Nevertheless, in the long term, the aim should be to completely discontinue cortisone.

Cortisone can be administered both locally and systemically (via tablets or intravenously
Giving medication through a vein. To do this, the vessel is punctured with a needle. A small plastic cannula is then inserted into the vein and an infusion is connected. As soon as this is finished, the plastic cannula is removed again.
) can be used. You will know the ointments for skin inflammation from your dermatologist. In the case of lung diseases, the inhalants are in the foreground. With normal doses, there are no systemic (i.e. affecting the entire body) side effects, but the mouth should always be rinsed out or the teeth brushed after inhalation.

However, with prolonged treatment, systemic side effects that affect the entire body can occur. This includes Cushing's syndrome with a full moon face, bull neck, facial flushing and brittle skin folds. Furthermore, it can lead to an increase in blood pressure and an increase in blood lipids. The rise in blood sugar can cause diabetes to develop. Many patients also complain about weight gain - the cause is usually a clear cravings when taking cortisone. There is water retention in the tissue, increased susceptibility to infection and increasing bone weakness (osteoporosis), which is essential with calcium and vitamin D with prolonged intake of cortisone
Vitamin D is the preliminary stage (provitamin) for a number of hormones that have a major influence on the calcium balance. The human body can produce this provitamin itself from cholesterol. The prerequisite for this is that the skin is sufficiently exposed to sunlight (UV light). If this is not the case, vitamin D must be taken in through food or supplementary preparations.
Vitamin D3 = Calcitrol - i.e. the vitamin D form that the body can use directly.
 
should be treated.

The vicious circle of immobility develops in COPD patients, for example, due to muscle weakness caused by cortisone, especially in the arms and legs (extremities). In addition, a parchment skin forms with punctiform hemorrhages in the tissue (petechial hemorrhages).

In order not to let the vicious circle of increasing immobility arise in the first place, cortisone should only be given a high dose for a short time, a low dose for a long time and then tapered off.

Patients can do a lot to reduce side effects: For example, keep moving! Lung sports groups are ideal for this. But a daily walk can also help. Also, quit smoking and limit alcohol consumption. To prevent weak bones (osteoporosis), in addition to exercise, it is advisable to consume dairy products as well as calcium / vitamin D substitution and, if necessary, the administration of bone building materials (bisphosphonates). A balanced diet is also recommended.

If you have to take cortisone regularly, you should also have regular medical check-ups. Your GP can do most of the simple tests. It is important that you have a contact person who knows you and can take changes and the symptoms you have described (such as back pain, susceptibility to infection) into account.

Corresponding to this topic, COPD Germany e.V., in cooperation with the patient organization Pulmonary Emphysema-COPD Germany, has published the patient's guide entitled: 'Cortisone - Miracle Cure or Devil's Stuff?', Which you can get free of charge in exhibition tent 3 at stand 1.

Source: Lecture by Dr. med. Urte Sommerwerck, Senior Consultant in the Clinic for Pneumology, Allergology, Sleep and Respiratory Medicine at the Helios Clinic in Wuppertal, at the 10th Lung Symposium on Saturday, September 2, 2017 from 9:00 a.m. to 5:00 p.m. in Hattingen (NRW ).

Please address inquiries regarding the symposium to:
Organizing Office Symposium Lung
Jens Lingemann
[email protected]
Telephone: 02324 - 999 959

All information about the event can be found here: Symposium Lunge 2017
You can also order a free program booklet.