Pulmonary - Critical Care Associates
of East Texas

Jeffrey M. Shea, M.D., F.C.C.P.
                              Venkatesh Donty, M.D.

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Corticosteroids (steroids)

Introduction

Frequently people have concerns about taking corticosteroid ("steroid") medications because they are not well informed about their benefits, indications and risks. Corticosteroids are anti-inflammatory medications for the treatment of allergic conditions, asthma and other diseases. They are NOT the same as anabolic steroids, used by athletes to increase muscle tissue.

Corticosteroids are related to cortisol, a hormone produced by the adrenal glands and one of the body’s own natural steroids. Cortisol is essential for life and well being. During stress, our bodies produce additional cortisol to keep us from becoming seriously ill.

Normally the adrenal glands release cortisol into the blood stream every morning. The brain monitors this amount and regulates the adrenal function accordingly. It cannot, however, tell the difference between its own natural cortisone and the steroid medicines. Therefore, when a person takes high doses of steroids over a prolonged period of time the brain my decrease or stop cortisol production. Health care providers generally decrease a steroid dosage slowly to allow the adrenal gland to recover and produce cortisol at a normal level again.

How do Corticosteroids Work?

No one knows exactly how corticosteroids work. Studies show that their effectiveness in asthma may relate to their ability to:

  • Decrease inflammation and swelling in the airways, lessening airway hyperactivity;

  • Reduce the release of body chemicals from certain inflammatory cells;

  • Increase the effect of bronchodilator medications.

Corticosteroid Preparations

Corticosteroid medications are available as nasal sprays, metered-dose-inhalers (inhaled steroids) and oral forms (pills or syrups). These are the most common prescribed forms of corticosteroids for most people with a chronic lung condition.

For many people with asthma, an inhaled steroid is the primary medication that is used to prevent symptoms. When taken on a regular schedule, an inhaled steroid reduces inflammation in the airways, making them less sensitive. Also, an inhaled steroid may help reduce symptoms associated with chronic bronchitis or chronic obstructive pulmonary disease (COPD).

An inhaled steroid is generally prescribed as a preventative medication. This means that you need to take it on a daily basis whether you have symptoms or not.  Most people with asthma benefit from using an inhaled steroid year round, but those with seasonal asthma may need to use it for only certain months of the year.

Your clinician may adjust the dosage of your inhaled steroid based on your symptoms, how often you use your bronchodilator to control asthma symptoms and your peak flow results. You may continue to need an occasional short-term burst of oral steroids when you experience more severe episodes.

An inhales steroid has a low risk of side effects when used at recommended doses. Studies show that the medication is usually broken down by the liver and very little circulates in the blood stream, thereby decreasing the risk of significant side effects. An inhaled steroid also has much less potential for side effects than oral steroids. The most common side effects with inhaled steroids are cough, hoarseness or a yeast infection of the mouth or throat (thrush). Using a spacer device with an inhaled steroid and rinsing your mouth with water (spitting after use) can help lessen these side effects.

Steroid Tablets

Oral steroids are given as a short-term burst or as routine maintenance therapy. Prednisone or methylprednisolone are most commonly prescribed as a tapered dose in increments of 40 mg. for four days, 30 mg. for four days, 20 mg. for four days, 10 mg. for four days, then stop. This is because they are short acting and reliably well absorbed and available to the lungs.

A short-term burst is generally used for severe episodes of your condition. Side effects that may be associated with a burst include mood swings, swelling, increased appetite, flushing of the face and high blood pressure. These side effects are the most common and usually disappear when the medication is stopped.

Long-Term Oral Corticosteroid Use

A small percentage of persons with chronic disease require the use of oral steroids for prolonged periods, possible weeks, months or longer. In several lung diseases, the primary treatment is high-dose oral steroids for several months or longer. If you have a lung condition such as asthma or COPD, the treatment program should include a combination of several medications other than oral steroids alone. If you have asthma, it is especially important that your treatment include an inhaled steroid with an adequate dosage before beginning maintenance oral steroids.

Steroid side effects usually occur after prolonged use with high doses. It is important to note that some people who take long-term oral corticosteroids experience only minimal side effects. Side effects, which may occur in some persons taking high-dose oral steroids, include:

  • Thinning of bones
  • Loss of blood supply to bones
  • High blood pressure
  • Glaucoma
  • Cataracts
  • Weight gain with increased appetite, fluid retention
  • Facial fullness
  • Increase in body hair and acne
  • a tendency to easy bruising and thinning of the skin, along with poor would healing
  • Muscle weakness or cramps, and joint pain
  • Changes in menstrual cycle
  • Elevation in blood sugar
  • Irritation of stomach and esophagus with possible ulcer symptoms
  • Emotional disturbances such as irritability, depression, euphoria or hallucination
  • Steroids may also suppress your body’s response to certain viral infections, for example varicella (chickenpox). If you or your child is exposed and susceptible to chickenpox while receiving oral steroids or high dose inhaled steroids, notify your physician immediately to determine if any special treatment is needed.

Some precautions can lessen your risk of side effects with long-term oral corticosteroids:

  • Take the steroid dose as a single dose in the morning, as this is closer to how the body produces its own natural steroid.
  • If prescribed by your physician, take the steroid every other day to minimize side effects
  • Take your steroid dose with food to lessen irritation of the stomach lining.
  • Take the full dosage (complete number of puffs) of your inhaled steroid as prescribed to allow the lowest possible dosage of oral steroids.
  • If you notice deterioration in peak flows or increased symptoms, notify your health care provider. A short course of oral steroids given early may help alleviate the need for longer courses if treated later.

It is extremely important to follow your physician’s directions. Don’t make any changes without his approval.

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