Steroid questions raised by new research
09 May 2006

New research has raised concerns about the extent of long-term use of inhaled corticosteroids for the control of asthma.

Dr Mike Thomas and colleagues at Aberdeen University looked at the prescription records of over 22,000 people with asthma, and found that 27% were on high doses of inhaled steroids, with 1 in 30 people with asthma taking steroids at inappropriately high levels.

Inhaled steroids are a vital part of asthma control for many people, and can help to prevent the occurrence of symptoms. These are not the same as the anabolic steroids used by some athletes, but mimic the natural steroids produced in the body. They work over a period of time by controlling swelling and inflammation in the airways.

UK clinical guidelines recommend that your doctor should prescribe the lowest possible dose that is effective in controlling asthma symptoms – this can then be stepped up if asthma is still not adequately controlled. Similarly, once your asthma is under control, high dosages should be reviewed so that they can be reduced to the minimum level at which they are effective.

There are some side effects associated with long-term use of high doses of steroids, which is why the UK guidelines recommend this ‘step-wise’ approach. The risk of side effects for anyone’s treatment is weighed up against their need for that treatment to prevent adverse effects from their asthma.

Guidelines also recommend that people with asthma should also have regular reviews and try other add-on therapies, such as long-acting reliever inhalers and preventer tablets, in addition to their usual medicines. However, in the study, Dr Thomas found that one third of patients were not receiving add-on treatments which could also help to control asthma at lower steroid doses.

The concerns raised by this study may sound familiar to many people who have asthma. If you are worried about your dosage of steroids, you should not stop taking your inhaler. Instead, seek a review with a doctor, asthma nurse or pharmacist to select the best possible combination of treatments.

'Even if your asthma is well-controlled, you should discuss your symptoms and medicine with your doctor or asthma nurse at least once a year, or more frequently for young children and people with severe symptoms or high doses of medicine,' recommended Rebecca Elder, an asthma nurse specialist on the Asthma UK Adviceline.

'Written personal asthma action plans agreed between you and your doctor or asthma nurse as part of your asthma review can also help you to keep control of your asthma and to be aware of the right level of medication,' she added.

'Be In Control' asthma action plans are available free from Asthma UK, and include information on what treatments should be taken; when and at what doses; what to do if your symptoms deteriorate and what to do in an emergency.

The study was reported in The Scotsman.