Shortness of breath ..dyspenia..while on prednisone

I was born with asthma. 73 now. Over the years I suffered from allergy related attacks. While on prednisone for PMR I developed GERD. I was only on steroids for 6 months. Its a nasty drug with all it left me with. I had two CT scans of the abdomen and pelvic neither showed anything. I then had a upper endoscopy. They found nothing but a slight hiatal hernia. Gastroenterologist recommended not letting the GERD get out of hand but no damage or cancer. Dr. recommended several drugs but I went with the 40mg famotidine. I thought that the easiest on side effects. I have to take one tablet every day to keep it under control but it works for me. Dr suggested the GERD could be causing the Dyspnea. She ordered a chest x-ray. Chest xray suggested COPD. Gastro sent me to a pulmonologist. I just finished all the testing and pulmonary says its not COPD its some slight scaring of my lungs probably from valley fever. I live in Phoenix. Bottom line is I had PMR 4 years ago and took steroids for 6 months. 4 years later I now take a drug for BP, Cholesterol, upper end A1C, GERD, and lung scaring. Probably none of these could I say were caused by prednisone or PMR. Could have just as easily been the COVID shot which made me sick. Could be at 73 its time to shut down. After all the testing they really couldn't find anything that was wrong. Good luck.

Dyspnea can be caused by various medical conditions or a combination of things. Dyspnea was actually one of my first complaints after I was diagnosed with PMR and took Prednisone daily. My belief is that both PMR and Prednisone caused my problem. My problem was called dyspnea on exertion (DOE) except it didn't take very much exertion to make me short of breath.
https://www.ncbi.nlm.nih.gov/books/NBK499847/#:~:text=Go%20to:-,Pathophysiology,respiratory%20tract%20and%20chest%20wall.
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I'm surprised your cardiologist said to stop diltiazem. When my doctor discovered I was having blood pressures in excess of 200/100, three blood pressure medications were started. My cardiologist blamed prednisone for my hypertension and said my heart wasn't beating effectively because of an arrhythmia. I also developed left ventricular hypertrophy (LVH) from excessively high blood pressure. My cardiologist said everything combined caused my shortness of breath.

I never developed GERD when I took Prednisone. I did get a bad case of norovirus which precipitated a "cascade of blood related events." An ambulance was called because I was extremely short of breath. I was eventually admitted to the intensive care unit. I thought people over reacted because I insisted that being short of breath was normal for me.

I couldn't believe that I had multiple and extensive pulmonary embolisms throughout both lungs. I tried to negotiate my way out of the emergency room by saying I needed to go home to take a meatloaf out of the oven. I promised to call my primary care doctor and make an appointment about being short of breath.

Than you.

Thank u for the above.
My dry cough and shortness of breath have me concerned.
I may try to see if pulmo will do a catscan re ..I hope not..but...pulm embolism.
So far my pulmo says my dyspenia and cough are just due to gerd. I am not so sure now at all. Robg

As per the taper: I started with 20mg Perd. and tapered 2.5mg each 30 days.
All was going well until I went from 10 to 7.5. Symptoms came back immediately. I went back to 10, and symptoms went away in 2 days. After some research, I found that the taper, after 10mg should be 1 mg each 30 days. I'm down to 6mg starting on Tuesday. I fired the Rheumatogist, as he refused to prescribe 1mg tablets, and insisted I take 7.5mg, even with the severe symptoms.
My new problem is that I've starting to feel weakness in the legs and dizzy. Not sure if this is a PMR problem or Prenisone? Or maybe something else.
Since doctor appointments are 3 - 4 weeks away, I can't get any help in the near term.

I forgot about having a dry cough. That was caused by one of the blood pressure medications that was started. Lisinopril and all ACE inhibitors are notorious for causing a dry cough as a side effect.
https://www.verywellhealth.com/lisinopril-causes-cough-1124151
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My primary care doctor switched me from Lisinopril to Losartin to control my blood pressure.

I'm reasonably sure Prednisone was the root cause of many of my problems. I have been off Prednisone for 4 years. Technically, I still have PMR because I'm still being treated for PMR but not with Prednisone. When I finally got off Prednisone, I was also able to discontinue all my blood pressure medications. I don't have any cardiac or pulmonary problems ... being short of breath all the time isn't on my list of problems anymore

"I fired the Rheumatogist, as he refused to prescribe 1mg tablets, and insisted I take 7.5mg, even with the severe symptoms. My new problem is that I've starting to feel weakness in the legs and dizzy. Not sure if this is a PMR problem or Prenisone? Or maybe something else."
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Probably not PMR if those symptoms weren't present at the start of PMR. I hate to say this but be prepared for a plethora of new symptoms after you taper down to less than 7 mg of prednisone. Those symptoms are probably caused by "long term" prednisone use. When you decrease your Prednisone dose too quickly you experience withdrawal symptoms.
https://www.medicalnewstoday.com/articles/322536#symptoms
Being dizzy all the time was a big problem for me when I tapered off Prednisone. My blood pressure dropped when I stood up too quickly. This problem was compounded by being on 3 blood pressure medications to control my high blood pressure when I was taking higher doses of Prednisone.

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What was your rheumatologist's rationale for not prescribing 1 mg tablets of prednisone? Never mind .. not prescribing 1 mg tablets isn't rational.

His ego. When I told him that the Mayo clinic plus 4 other respected enities recommend 1mg taper after 10mg, he told me if I wanted 1mg tablets I should just go to the Mayo Clinic.
This the second Doctor I have had to quite because they cannot stand to have a patient question their so called wisdom.
To add: I had to self diagnose my PMR, because after 2 visits, that doctor couldn't figure out what it was. Then I had her order the blood tests, and then the Prednisone. Actually she was the first doctor I quite on, plus two rheumatologists. I haven't had much luck with doctors lately. I least I have a good new MD. Amongst other things, he's willing to order the Prednisone I need.

I can appreciate your concern. On my taper from 20 mg of 1 mg per month, I got down to 2 mg and had a bad reaction. Dr. said to go back to 5 but I didn't wnt to go that far back so only went to 3. After a couple of months I tapered down to 0. For four days, I felt some energy return and my brain became more clear. I then went to see my primary care doctor who gave me a COVID 19 booster and my weakness and mental fog has returned. I don't know if the injection had anything to do with the relapse, but I'm hoping the improvements will return eventually. At least I seem to be through with Prednisone, God willing.

I'm not making excuses for your rheumatologist.

There are many entities including doctors from Mayo and internationally that recommend tapering but 1 mg every 4 weeks after reaching 10 mg of Prednisone. However, there is a provision for a 10/7.5 mg alternate day schedule.
https://ard.bmj.com/content/74/10/1799
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"The panel strongly recommends individualising dose tapering schedules, predicated to regular monitoring of patient disease activity, laboratory markers and adverse events.
The following principles of GC dose tapering are suggested:
A. Initial tapering: Taper dose to an oral dose of 10 mg/day prednisone equivalent within 4–8 weeks.
B. Relapse therapy: Increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4–8 weeks) to the dose at which the relapse occurred.
C. Tapering once remission is achieved (following initial and relapse therapies): Taper daily oral prednisone by 1 mg every 4 weeks (or by 1.25 mg decrements using schedules such as 10/7.5 mg alternate days, etc) until discontinuation given that remission is maintained."
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It sounds like you had a relapse at 7.5 mg. In that case the taper should be done gradually and probably slower.
In any case:
E. Patients should have an individualised PMR management plan. Patient perspective and preferences should be considered in the individualised choice of initial GC dose and subsequent tapering of GCs in PMR.
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These recommendations date back to 2015 and need to be updated. They predate Actemra and Kevzara. Biologics are now being used more often in the USA. When I started Actemra, I had to wing it and nobody gave me any instructions about how I should taper Prednisone. I wasn't sure what to do with the injections they sent me, My rheumatolgist told me to do injections every 2 weeks to "play it safe!"
A. I tapered by 1 mg per month from 10 mg to 7 mg.
B. Then I tapered by 1 mg per week from 7 mg to 3 mg. (I wanted to get the inevitable PMR flare over with except I didn't have a relapse.)
C. My rheumatologist and my endocrinologist concurred that I should stay on 3 mg until my cortisol level improved. I needed to stay on 3 mg for 6 months.
D. Then my endocrinologist said that 3 mg of Prednisone was such a small dose that I could simply stop Prednisone without tapering because my cortisol level was "adequate."
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Things really got interesting after I discontinued Prednisone the first time. I had a relapse but not a PMR relapse. My ophthalmolgist put me back on 60 mg of Prednisone and wanted to try a different biologic. I will save the details about what happened next but I managed to get off Prednisone even faster when the other biologic was stopped and more frequent Actemra injections were restarted. Now I do a monthly IV infusion of Actemra that works well too.