Glucocorticoid-induced myopathy

Q: 52 years old female with severe history of steroid-dependent asthma is admitted to ICU with impending respiratory failure, requiring intubation. Glucocorticoid-induced myopathy is suspected. Glucocorticoid-induced myopathy is irreversible?

A) True

B) False

Answer: B

Although fluorinated glucocorticoid preparation like dexamethasone is less likely to cause myopathy than nonfluorinated preparation such as prednisone, weaning and discontinuation is the best treatment to resolve myopathy. Fortunately, this weakness is reversible. Although resistance exercises and using the lowest possible dose may help, prolonged intake of steroids eventually takes its toll on the muscle.

Less appreciated is the fact that glucocorticoid myopathy may affect the respiratory muscles like our patient in the above question. In this population of patients, lower inspiratory muscle strength and endurance are reported, though there is no evidence of decreased maximal expiratory pressures.

#pulmonary

#pharmacology

#musculoskeletal

References:

1. Bowyer SL, LaMothe MP, Hollister JR. Steroid myopathy: incidence and detection in a population with asthma. J Allergy Clin Immunol 1985; 76:234.

2. Akkoca O, Mungan D, Karabiyikoglu G, Misirligil Z. Inhaled and systemic corticosteroid therapies: Do they contribute to inspiratory muscle weakness in asthma? Respiration 1999; 66:332.

3. Wu K, Michalski A, Cortes D, et al. Glucocorticoid-induced myopathy in people with asthma: a systematic review. J Asthma 2022; 59:1396.