Summary: Prednisone and cortisone are both glucocorticoid drugs that are used to treat inflammation and immune system disorders. However, prednisone is a much stronger glucocorticoid and is a preferred treatment in conditions like asthma. One of cortisone’s advantages is that it’s available in injectable form and is often used to treat inflammation in joints.
Dear Curtis: This is probably a stupid question but a buddy of mine and I got to arguing the other day about the difference between cortisone and prednisone. I’ve gotten a cortisone shot before and he occasionally takes prednisone for his asthma. He said you couldn’t use cortisone for asthma but, aren’t they both steroids? Don’t they both do the same thing in the body?
Will it help if I say you are both right?
Before I get to the heart of the answer I need to explain some misunderstanding’s that I see a lot with this group of drugs.
First of all, they are all ‘steroids’. Not the type of steroids that certain athletes abuse. But steroids in the sense that they are ‘glucocorticoids’. They’re called steroids because their chemical structure has a ‘steroid’ backbone.
Essentially, both cortisone and prednisone fall into the glucocorticoid class of drugs. Glucocorticoids are naturally produced in your body, especially during times of stress. For example, cortisol is naturally secreted as part of your immune response and helps turn it down so it doesn’t get out of control. Glucocorticoids are also heavily involved in the process of lowering inflammation in our bodies.
Now, for the purpose of you and your friends ‘discussion’ – let’s take his asthma as our example.
Asthma, at it’s heart, is an inflammatory process. In asthmatics their airways become inflamed and, if left untreated, their airways can close up. Now, sometimes the bodies stress response isn’t enough or appropriate and so they need ‘outside’ steroids to help control it. That’s when you start giving the outside glucocorticoids.
You can, and often do, also give asthmatics steroid inhalers so the steroid can get right to the spot of the inflammation and you can avoid some of the body-wide side effects of taking a steroid by mouth.
Using Glucocorticoids In Asthma
I think where you guys are probably getting your wires crossed is about the form of cortisone that is being used.
You see, when you say cortisone you are talking about the shot. One of the advantages of the cortisone shot is just that … it’s a shot. So you can direct it’s effects to exactly where you want them. That’s one of the reasons why you see people who have had, say, a sports injury in their knee where there is inflammation involved. I’ve had cortisone shots in my elbow because of inflammation. The list can go on. And, as you’ll see below, some cortisone shots are followed up with prednisone tablets to be taken by mouth.
But, obviously, you can’t inject cortisone into the lungs to treat asthma. So, in that regard your buddy is right. But cortisone comes in more than one form and is available in an oral tablet as well. Which, technically, could be used to treat asthma.
However, it’s highly likely it won’t be. Why?
If you look at prednisone and compare it to cortisone one major difference will pop up. And that is prednisone is a much stronger glucocorticoid than cortisone. And, as you saw above, a glucocorticoid is something that knocks down the immune response and inflammation.
So, in asthma, which is a disease characterized by inflammation. Prednisone would be the preferred treatment because it’s – on average – five times stronger as a glucocorticoid.