My doctor wants me to take inhaled corticosteroid medication to improve my asthma control, but I am reluctant to take steroids because I heard from a friend that they are dangerous drugs. Are steroids dangerous?
No, steroids are not dangerous if taken as prescribed. Your physician has the requisite expertise to make a medically appropriate recommendation about your asthma treatment.
He or she is invested in your well-being and obviously would never suggest an intervention of any sort that would harm you or not provide you with a benefit. Furthermore, every prescription medication sold in the United States has passed the FDA’s rigorous approval process. Corticosteroids are no exception; like any other class of medicine, steroids are safe and effective when prescribed appropriately, and when used exactly as directed.
Steroids are not inherently any more or less dangerous than other medicines. Like any other class of medicine, they do carry potential side effects, especially if used in pill form (as opposed to inhaled), long term, and in large doses. Steroid preparations have important and diverse medical uses. The development of inhaled corticosteroid medicines has revolutionized the treatment of asthma and greatly improved the quality of life of countless persons with asthma. Steroids come in formulations other than pills and inhalers.
An allergic child with eczema may be treated with a steroid cream, for example. Similarly, ophthalmologists may prescribe steroid eye drops for specific conditions. Steroids are a powerful medicine in the pulmonologist’s and allergist’s armamentarium, and they can be truly lifesaving in certain medical situations, including a severe exacerbation of asthma.
Why, then, might some people erroneously think that steroids are dangerous? Some confuse anabolic steroids with corticosteroids. Anabolic steroids have been abused by some weight lifters and athletes to help them bulk up and build muscle mass, and they have a reputation for causing dangerous side effects when misused. Corticosteroids are completely different medicines than anabolic steroids and are the class of steroid medication used extensively in treatment of allergy and asthma.
Another reason your friend might think of steroids as “dangerous” is that, when prescribed in oral form (pills or syrup) they have to be taken exactly as directed, in a very specific manner. If your doctor instructs you to take tapering or decreasing doses daily, for example, then you should follow the physician’s directions to the letter. There are at least two important reasons for you not to stop taking the pill form of corticosteroids abruptly.
The first reason is that if corticosteroids are prescribed for treatment of an exacerbation of asthma, there is a good chance that the asthma will flare anew if the steroid dosage is decreased all at once. The second reason applies in the scenario of an individual who requires steroids on a long-term basis. Our bodies all produce a form of steroids that is required for health. The right and the left adrenal glands located above each kidney are responsible for meeting the body’s steroid requirements.
The steroids produced by the adrenal glands are referred to as the body’s “endogenous steroids.” When the adrenal glands detect extra steroid medication in the bloodstream over time, they reduce their own endogenous steroid production. If the adrenal glands are exposed to a significant amount of steroid medication, they respond by completely shutting down the body’s own vital manufacture of steroids.
As long as a person continues to take his or her prescribed steroid medication, the adrenals remain “lazy” and cease the production of endogenous steroids.
When steroid medication is then gradually reduced, the adrenal glands have time to “wake up,” and will eventually resume producing sufficient endogenous steroids for the body’s needs. If, on the other hand, long-term steroid pills are stopped abruptly, the adrenal glands will not have sufficient time to recover and to restart the manufacture of endogenous steroids. The body will be left without any steroids at all, and an adrenal crisis—a true medical emergency—may ensue. The treatment of adrenal crisis requires hospital admission and includes steroid administration by the intravenous route.
Steroids are safe when taken exactly as prescribed, for bona fide medical indications. The only danger to using them occurs if they are not used correctly. If your asthma requires daily oral steroids, it is vitally important that you follow the physician’s dosing recommendations. Let’s say that your asthma has become less con-trolled.
Despite the fact that you are using inhaled, long-acting β2 agonists (LABA), along with an inhaled, high-dose corticosteroid twice a day, you are now also requiring two puffs of your quick-relief, short-acting inhaled β2 agonist (SABA) every 4 to 6 hours for relief of breathlessness. Your peak flow values decreased yesterday and are still lower than usual today.
You have been experiencing nocturnal awakenings for the past six nights because of respiratory difficulty. You feel unwell and are breathless with climbing half a flight of stairs or walking short distances. Your physician will undoubtedly prescribe a steroid burst for you. A steroid burst is a prescription for corticosteroid pills that you will take daily for a limited period of time (usually 6–21 days, depending on your asthma).
You will begin with higher doses, in order to get your asthma under control, followed by gradually decreasing doses, before finally tapering off the medicine. You can expect to begin to feel an improvement in your asthma exacerbation in as little as 6 hours after the first dose of steroid pills. When used properly, steroids are truly miraculous in their effectiveness.
Prednisone and methylprednisolone (Medrol) are two different steroids in pill (or oral) form that are frequently pre-scribed in the treatment of asthma exacerbations and of severe allergic reactions. They are also sometimes recommended as controller therapy in very small daily doses in the treatment of severe persistent asthma. A 5-mg dose of prednisone is equivalent to a 4-mg dose of methylpred-nisolone (Medrol). I usually advise my patients who require steroids to start them early and get off them quick-ly, so they can take advantage of the beneficial qualities when treating an exacerbation and minimize potential side effects. Before inhaled formulations became available, the chronic use of oral (pill or liquid by mouth) corticos-teroids was responsible for both saving many lives and causing significant side effects.
Because of the availability of inhaled (and nebulized) steroids, the potential for the development of serious systemic (body-wide) side effects has decreased dramatically. Corticosteroids are pharmaco-logically potent; that’s one reason they work so well! That said, I do not hesitate to write a prescription for an inhaled or oral steroid whenever the clinical situation is appropri-ate. I also carefully review the relative potential risks, anticipated benefits of the medication, and answer any questions such as the one you are posing here.
Kerrin’s comment:
My son was prescribed Pulmicort Respules after being hospitalized for respiratory problems. We’ve been instructed to use it in the nebulizer after the albuterol (which we were told opens up the breathing passages to then allow the steroid better movement) whenever we believe his breathing is becoming compromised. It’s a steroid, but it has helped keep him out of the hospital (where he would receive steroids anyway) several times, so whatever the possible side effects, they’re worth it.