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Patients on dexamethasone may experience fewer overall side effects due to its relative lack of mineralocorticosteroid effects and consequently lower sodium retention than seen with other steroids[6,10]. The most severe and troublesome side effects usually occur with dexamethasone withdrawal in patients who receive extended dosing or who continue to receive a high dose, causing renal problems. These include increased blood pressure, increased cardiac rate, and increased systemic blood sugar. In many patients, these side effects may be resolved in 2–3 months. Long-term use of dexamethasone (up to a maximum of 24 months) is not recommended. Intracranial arterial dissections have been shown to be associated with the adverse effects of dexamethasone, including hypotension, reduced blood pressure, increased heart rate, and decreased respiratory rate . Although the incidence of long-term effects, e.g., acute myocardial infarction, is low, the long-term effects of dexamethasone are likely to be worse than that after other agents [16,17]. The drug is associated with an increased risk of mortality in those treated with long-term therapy . Open in a separate window DEXAMETHASONE IN OLDER FATHER AND DYSPEAKERS OBJECTIVES OF THE STUDY To evaluate the safety and efficacy of intranasal administration of dexamethasone in older patients with respiratory complications such as pneumonia (e.g., pneumonia) and otitis media among whom bronchiolitis obliterans is common. Design: Prospective cohort study to evaluate the clinical safety and efficacy of intranasal administration of dexamethasone in older adults with respiratory complications. Methods: We performed a randomized, double-blind trial in 1,539 patients with pneumonia or otitis media on sustained (5 or more days of intensive respiratory therapy or mechanical ventilation with intranasal administration of dexamethasone) or no therapy for 8 weeks. Follow-up (n = 817) and objective data were collected at weekly visits for 12 months. Results: After adjustment for multiple testing the incidence of hospitalization for otitis media/pneumonia was 4.8 (95% CI, 3.1–7.5) per 10,000 patients, whereas 6.6 (95% CI, 4.1–7.3) of 817 patients with pneumonia died. The incidence of mortality was 2.5 per 10,000 patients. There was no increase in the incidence of acute upper airway infections. There was, however, a non-significant increase in the incidence Similar articles: