Is it safe for a 69-year-old with polyps to try Prednisone?

Hello,

Welcome to icliniq.com.

I understand your concerns.

Oral Prednisone is quite harmful and should be avoided if at all possible given the patient's advanced age, prior bone loss and borderline blood sugar levels. Even a short course of the medicine in the body can lead to dangerous spikes in blood glucose and accelerate the loss of bone density. He can no longer take oral steroids, which increase the long-term risk of fragility fractures occurring without warning.

The best clinical approach is to optimize local therapy using high affinity topical nasal corticosteroid sprays such as mometasone or fluticasone. These sprays go directly to the inflammatory region with virtually no systemic absorption therefore they would not negatively effect his bones or glucose levels.

Moreover, the use of modern biologic medicines such as Dupilumab, which are very successful for severe recurrent polyposis and safe regarding metabolic profiles, should be strongly discussed with his ENT (ear, nose and throat) expert.

If conservative measures do not keep the airway open, a repeat functional endoscopic sinus surgery (FESS) is a far safer long-term alternative to numerous courses of oral steroids.

Large-volume daily saline nasal irrigations should also be started to clear inflammatory debris and maximize administration of the nasal sprays.

If a short course of oral Prednisone is absolutely necessary because of severe airway blockage, it should be as short as possible with thorough daily monitoring of glucose levels, a limited carbohydrate diet and focused bone protection with calcium and vitamin D3 supplements.

Hopefully this makes sense and is useful.

If you have any more queries or require any clarification, I am here to help you.

Thanks for reaching out!