What's the connection: Corticosteroids and behavior?

AHA!

This might be one of the "other sources":
http://www.askapatient.com/viewrating.asp?drug=20441&name=PULMICORT

Looking through the list at like aged children it seems that some of Mo's reactions are pretty common.

boomer, does he have asthma attacks that require medical attention?

But isn't plain old asprin an anti-inflamatory? (One that doesn't cost $160 and cause behavior problems, I might add.) If that was all these steroids did wouldn't it make sense to find something easier on one's system?

Here's what usually happens:

He gets a cold, or now, I guess comes across something that he is allergic to.

I give him some Motrin or some Benedryl thinking it isn't anything serious.

He starts coughing. I notice that he is breathing shallowly (?). I start him in on the Albuterol. In a couple of days he's back up to speed.

Twice now he has had to have doctor's visits with nebulizer treatments and steroid prescriptions.

He has never had the kind of asthma attack where he is gasping for breath or seems oxygen deprived. Only once has he been bagpipe-type wheezy.

Honestly, I would have never thought he had asthma if the doctor hadn't been so insistent because he is usually so healthy and active and doesn't have problems. Mr. B was still kind of denying that asthma was the problem. I was really glad yesterday that my car is (still) broken and Mr. B had to take us to the doctor. He had to sit and listen to someone other than me. Good.

I don't want Mr. B (or me) to be all "ACK! Mo is sick. We have to keep him still for the rest of his life. He's so delicate and fragile." but... well... we both need to pay attention and realize that this very robust boy has a health issue that needs attention.

Is he seeing an allergist? If not, I think it's time.

An allergist makes sense.

Also, can you find someone to tutor you in the Oriental Mysteries of controlled breathing? Then you can pass the information on to Mo.

A dash of Oriental Calm wouldn't hurt you, either.

Oriental calm! Some opium might just do the trick!

An allergist, huh? I'll look into that.

This year allergies have been completely wack here.

At the doctor's suggestion I have started keeping an asthma journal. The first entry: Don't cross the Cascades in the spring.

Boomer--

Try not to buy from the Taliban.

Actually, if you plant some poppies, you can make a legal narcotic tea.
Meanwhile.........

My asthma journal involves Don't catch a cold.

In the old days, it involved, Don't swim a mile.

Don't cuddle cats. Take antihistamine when going to cousin's house.

In northern CA, it involved, Don't walk when a lot when it is cold and foggy.

Steroid compounds tend to thwack at the immune process basic to asthma - I'm sure I've read the details, but a long time ago.



Decades ago, I had rampant allergic rhinitis, plus the odd occasion of asthma. That all started in a city of heavy smog at the time, when I had a history class in a dust bowl of a classroom, and when I had just started smoking, on top of all that, getting contact lenses. Sneeze, where's my lens? Ramped up when we had guinea pigs in the lab, and later when my husband came into my life with two cats.

The rhinitis has basically disappeared. That all morphed to hives, periodic itchyness, mild excema. I started to remember all the sneezing almost fondly. By then I tended to have more routine after cold asthma bronchitis stuff.

I've never had the kind of asthma where you can't possibly catch your breath, though I have gotten a bit scared in the middle of the night.

There's one good thing about asthma though. It makes me care about breathing well. Thus after I quit smoking, I've no inclination to go back there.

Mo's asthma sounds mild but real.

I don't have any medical suggestions but seeing an allergist is a good idea, establish a baseline with a specialist in the field.

If he reacts to certain pollen, that is one thing, if it is to inflamation at the end of a cold, it's another...

I have found a component of progression in my own allergy-asthma, as in, let it go, it gets worse. Sometimes I could stop it with distraction, whatever that is about. Last few times I had it, it was with the after cold cough thing, and a certain honey cough syrup seemed to help to not get me started with it. Not a clue how indicated or contra-indicated that would be for a child.

Well, all my stuff is rather mild. My business partner had more serious stuff, really compromised lungs, tough for an athletic person.

Hmmmmm...a lot of aspirin like antiinflammatories can TRIGGER asthma...


I would guess there must be a problem finding ones that don't...hence the nasty ones we use.

The following adverse events occurred with an incidence of 3% or more in at least one PULMICORT RESPULES group where the incidence was equal to or less than that of the placebo group: fever, sinusitis, pain, pharyngitis, bronchospasm, bronchitis, and headache.

Incidence 1% to ≤3% (by body system)

The information below includes all adverse events with an incidence of 1 to ≤3%, in at least one PULMICORT RESPULES treatment group where the incidence was higher with PULMICORT RESPULES than with placebo, regardless of relationship to treatment.

Body as a whole: allergic reaction, chest pain, fatigue, flu-like disorder
Respiratory system: stridor
Resistance mechanisms: herpes simplex, external ear infection, infection
Central & peripheral nervous system: dysphonia, hyperkinesia
Skin & appendages: eczema, pustular rash, pruritus
Hearing & vestibular: earache
Vision: eye infection
Psychiatric: anorexia, emotional lability
Musculoskeletal system: fracture, myalgia
Application site: contact dermatitis
Platelet, bleeding & clotting: purpura
White cell and resistance: cervical lymphadenopathy

The incidence of reported adverse events was similar between the 447 PULMICORT RESPULES-treated (mean total daily dose 0.5 to 1 mg) and 223 conventional therapy-treated pediatric asthma patients followed for one year in three open-label studies.

Cases of growth suppression have been reported for inhaled corticosteroids including post-marketing reports for PULMICORT RESPULES (see PRECAUTIONS, Pediatric Use).

Less frequent adverse events (<1%) reported in the published literature, long-term, open-label clinical trials, or from marketing experience for inhaled budesonide include: immediate and delayed hypersensitivity reactions including rash, contact dermatitis, angioedema, and bronchospasm; symptoms of hypocorticism and hypercorticism; psychiatric symptoms including depression, aggressive reactions, irritability, anxiety, and psychosis; and bone disorders including avascular necrosis of the femoral head and osteoporosis.
DRUG INTERACTIONS

In clinical studies, concurrent administration of budesonide and other drugs commonly used in the treatment of asthma has not resulted in an increased frequency of adverse events. The main route of metabolism of budesonide, as well as other corticosteroids, is via cytochrome P450 (CYP) isoenzyme 3A4 (CYP3A4). After oral administration of ketoconazole, a potent inhibitor of CYP3A4, the mean plasma concentration of orally administered budesonide increased. Concomitant administration of other known inhibitors of CYP3A4 (eg, itraconazole, clarithromycin, erythromycin, etc.) may inhibit the metabolism of, and increase the systemic exposure to, budesonide. Care should be exercised when budesonide is coadministered with long-term ketoconazole and other known CYP3A4 inhibitors. Omeprazole did not have effects on the pharmacokinetics of oral budesonide, while cimetidine, primarily an inhibitor of CYP1A2, caused a slight decrease in budesonide clearance and a corresponding increase in its oral bioavailability.

www.rxlist.com

Corticosteroids are steroids that are synthesized in the cortex of the adrenal gland. One such corticosteroid is cortisol, which is involved in the response to stress.

Critical to corticosteroid level is the activity of various microsomal enzymes, as these proteins regulate both steroid degradation and metabolism to other metabolically active ( and inactive ) compounds.

Rats make a lot of corticosterone when they're growing up if their mother's aren't very attentive to them or if they aren't getting enough food -- that is, if they're stressed. It makes a certain amount of intuitive sense that a corticosteroid drug might make a kid act like like that -- like a stressed out kid.

On the other hand, if he's in kindergarten (new experience) AND he has trouble breathing -- well, he's going to be a stressed out kid. Probably both the drug and his health problems at work (since I'm assuming he only gets the drug when his asthma is a problem).




Aspirin (and other non-steroidal anti-inflammatory drugs from Advil to Vioxx) stop inflammation at the source by stifling some of the chemical signals that trigger it. So aspirin won't really work if the problem is in the cells, and not in the chemical soup, like it is in allergy (asthma). Steroids, among other things work by keeping some of the cells of the immune system from working.

Steroids also change the way your nervous system responds to things, raise your blood sugar, impair your immune system's ability to fight viral infection, and change your metabolism at pretty much every level. They are very, very potent drugs.

If there is a better way to treat the signs, it might be a good idea. Mo's brain is still wiring itself, and the steroids may make it do so in less-than-ideal ways.

In stressed baby rats, for instance, it leads to grown-up rats who get stressed out easily and are more likely to raise stressed-out rats themselves.

An allergist would be able to tell you about the latest therapies -- generally the therapies with the most negligible side effects. Highly selective drugs that work on particular components of the immune system are HUGE business for the pharmaceutical companies and real improvements are made on a regular basis (as opposed to drugs where the company will actually patent and advertise a drug that doesn't even work as well as the drug it's meant to replace).

A family practitioner or a pediatrician could easily fall behind on the best options for treating these things.

(Or maybe not. Asthma is kind of a stumper.)

That's what I think, too. It's also important to go through the skin sensitivity tests to determine what Mo's allergic to. They can tailor desensitization shots for him once they know that. That worked for my guy. I doesn't get rid of the allergies, but they did lesson the reactions some.

Could the attack have been triggered in part by the pleasant excitement of a weekend away? A weekend out-of-the-ordinary?

What does the doctor say about preventing attacks by anticipating stress situations with an antihistamine?

Very much agreed about seeing the specialist (allergist). Again, you know my experience with the family practice doctor and then the specialist (ENT) -- they're on completely different wavelengths in terms of how to best approach the problem (and I infinitely prefer the ENT!). The family practice guy is young and smart and I don't think there is anything wrong with him per se, but he clearly wasn't up on the very latest in a way that the specialist is.

Thanks all!

I'm familiar with the child studies that mimic the results of the rat studies!

We honestly don't know what triggered the attack but an allergy is suspected (itchy, watery eyes, congestion being other symptoms) but it was an exciting weekend - Mr B and Mo did a lot of dirt biking, Mo had a little crash (he's not hurt) that scared him pretty bad and he cried pretty hard (that could have been it) and we were at an elevation about 2950 feet above our usual (that could have been it).

Last night even his pajamas hurt. He had a few nightmares. This stuff is crazy making.

He's agreed to go to school today if I will go with him. Luckily his teacher can always use an extra pair of hands and it's art literacy day and that's always fun.

I will spend the weekend looking for an allergist.

Good luck, boomer.

Yes, good luck to you!

I hope you and Mo are enjoying art literacy day. That's sounds fun.