In regards to Dex administration being contraindicated for patients currently on parenteral or PO steroids, can we get some more clarification on what we are referring to specifically - is it basically all steroids? Most patients with COPD tend to be on steroid puffers which presumably would make those patients not able to receive dexamethasone?
Inhaled steroids are not considered PO or parenteral steroids. Therefore, patients on steroid puffers are not contraindicated for dexamethasone administration.
Further clarification can be found in the OBHG Companion Document, When treating with dexamethasone, the contraindication to steroids only applies to systemic steroids (PO, parenteral) and not inhaled or topical steroids. Inhaled steroids are very specific to lung tissue and do not contribute to systemic absorption.
In addition, there is a comprehensive Dexamethasone module on the Paramedic Portal of Ontario, under the 2022 MCME course. This course describes in detail the pathophysiology of the conditions treated by Dexamethasone as well as the drug pharmacokinetics/pharmacodynamics and the Medical Directive, including the details of the contraindication of PO or parenteral steroids.