Patients requiring oral corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to ALVESCO. Prednisone reduction can be accomplished by reducing the daily prednisone dose by mg on a weekly basis during ALVESCO therapy [see DOSAGE AND ADMINISTRATION ]. Lung function (FEV 1 or AM PEFR), beta-agonist use, and asthma symptoms should be carefully monitored during withdrawal of oral corticosteroids. In addition to monitoring asthma signs and symptoms, patients should be observed for signs and symptoms of adrenal insufficiency, such as fatigue, lassitude , weakness, nausea and vomiting, and hypotension .
Steroids have no positive influence upon pulmonary related morbidity and mortality following combined smoke inhalation and thermal cutaneous injury (3, 4). Steroid administration following isolated smoke inhalation without concomitant thermal cutaneous injury has, however, been shown to have beneficial effects in previous animal studies (1). This potential therapeutic approach to treatment has not been examined in the clinical setting. Recent hotel fires in Las Vegas, Nevada, resulted in a large cohort of individuals with similar smoke exposures without associated injuries. Two of four hospitals in the triage system administered steroids following injury. Patients were divided into two groups, a steroid-treated, and a non-treated group. These groups were compared using multivariate and frequency analyses. There were no detectable differences in sex, signs, symptoms, and previous medical history. There were likewise no differences between groups with respect to oxyhemoglobin saturation, arterial oxygen tension, arterial pH, and pulmonary-related morbidity and mortality. These data suggest that steroid coverage has little beneficial effect upon pulmonary-related morbidity and mortality following isolated smoke inhalation injury.
Induction of methemoglobinemia is theoretically dangerous in a patient with an elevated carboxyhemoglobin level because further reduces oxygen-carrying capacity, so the clinician should consider withholding the nitrite portion of the kit. Another drawback of this treatment is the delayed onset of thiosulfate. Note that there is limited information about the efficacy of sodium thiosulfate for CN poisoning, as there are no clinical trials of sodium thiosulfate available. [ 12 ] Finally, this treatment may be more preventative rather than curative.