Steroids in brief
Many children and most adults with asthma are prescribed medicine that contains 'corticosteroids' - a copy of the steroids produced naturally in your body.
Steroids help to calm inflamed airways and stop inflammation by blocking the effects of certain chemicals your immune system uses to 'kick-start' the process of inflammation.
Taking steroid medicines makes it less likely that you will experience symptoms such as coughing, wheezing and shortness of breath. It also means it's less likely that your body will react to asthma triggers, such as pollen or pollution.
Like all prescription drugs, there is a risk of side effects when you take steroids. But you'll only ever be prescribed them if the benefits outweigh the risks.
Steroids can be prescribed in different ways:
- Your preventer inhaler taken every day contains the lowest dose of steroids possible to help manage your symptoms. If you take it properly and regularly as prescribed, it helps to reduce your risk of an asthma attack.
- If your asthma symptoms become severe or you have an asthma attack, your GP or asthma nurse may give you a course of steroid tablets (called prednisolone). These contain a much higher dose of steroids.
- A very small number of people with severe asthma need to take a small dose of steroid tablets for longer periods - perhaps months or years, or may be given an injection (called Kenalog, also known as Triamcinolone) at intervals decided by your specialist. People requiring long-term treatment with oral steroids or requiring steroid injections for their asthma should be under the care of a hospital consultant specialist.
Get the best from your steroid tablets
If you manage your asthma well, you are less likely to need to take steroid tablets. If your asthma symptoms do become worse (where there's increased inflammation and narrowing in the airways, and often a sticky mucus or phlegm is produced) and/or you have an asthma attack, your GP or asthma nurse may give you a course of steroid tablets.
The dose and length of the course will depend on your age, how you respond to the treatment and how long it takes you to recover. You need to continue taking your preventer inhaler as prescribed when you're taking steroid tablets.
For adults, steroid tablets are usually prescribed for at least five days. For children, steroid tablets are usually prescribed for up to three days. The course may be longer depending on how long it takes you or your child to fully recover.
It is important that the tablets are taken as prescribed and you don't stop taking them before the course is finished or you're fully recovered. Why? Because if you don't finish the course or you finish them but you're still not fully recovered, your airways may still be inflamed and your asthma symptoms may come back again and your risk of having a potentially fatal asthma attack will go up.
"Fully Recovered" means:
- Having few or no symptoms of cough, wheeze, tightness in the chest, difficulty breathing
- Hardly using your reliever inhaler (usually blue)
- If you use a peak flow meter, your peak flow reading is back to above 75 per cent of your personal best
If you or your child finish a short course of steroid tablets but you're/they're still not feeling better, see your GP or asthma nurse straight away to review your/their treatment. You/they may need a longer course of steroids.
Possible side effects of steroids
Like all prescription drugs, there is a risk of side effects when you take steroids. It's important to remember that most people who take them won't experience them all, or even any. And you'll only ever be prescribed a medicine if the benefits outweigh the risks. If you feel worried about anything, speak to your GP or asthma nurse. We have a useful Q&A about the common concerns people have about taking asthma medicine here. You can also speak to an asthma nurse specialist by calling our Helpline on 0300 222 5800 (9am - 5pm; Mon - Fri).
What's the best way to lower the risk of side effects from steroids?
All medications carry risk of side effects and it is important to balance this with the important benefits that the drugs may have. In asthma your doctor/nurse will be trying to get you on the lowest doses of medication that will completely control your symptoms. The dose of steroid going into your body is much higher if you are taking them in tablet/injection form for a flare-up of your asthma than it is by taking regular (low to medium) steroid inhalers.
- Take your preventer inhaler every day exactly as prescribed. By keeping the inflammation in your lungs under control, you are less likely to have a flare-up which can be life-threatening and result in you needing high doses of steroids by mouth or injection. Make sure you know how to take your inhalers correctly. Incorrect inhaler use can lead to less of the inhaled steroid reaching the parts of your lungs that need it and more being absorbed into your bloodstream. Incorrect inhaler technique will also increase your risk of local side effects, including oral thrush.
So even if you're feeling well, it's really important to keep taking your preventer inhaler so that it can work away in the background to help treat the inflammation in your lungs that causes symptoms and increases your risk of an asthma attack.
- If your GP or asthma nurse thinks you need a course of steroid tablets it is important that you, take them as prescribed and finish the course. If you avoid taking them, you're putting yourself at risk of a potentially life-threatening asthma attack, which may need treating with even larger doses of steroids.
- Don't smoke. There's very clear evidence that if you don't smoke, your preventer inhaler works better, so you're less likely to need steroid tablets. Research shows that if you smoke, giving up may mean you need a lower dose of preventer inhaler. Passive smoking is also important. If someone you live with gives up, this may also improve your disease control and mean that you can consider reducing your dose. There's useful information on how to quit here.
- Make sure you get an annual asthma review where you can check with your GP or asthma nurse that you're taking the right medication at the correct dose and in the right way. Your community pharmacist can also advise you on your medications and check your inhaler technique. If you haven't had any asthma symptoms for at least three months, your GP or asthma nurse may be able to reduce (step down) your medication dose.
What are the common side effects?
Possible side effects of preventer inhalers
If you take your preventer inhaler in the correct way as prescribed by your GP or asthma nurse, the steroids in it are unlikely to cause many side effects because more of the inhaled medicine goes straight down to the airways where it is needed. Very little is absorbed into the rest of the body. If you're taking a higher dose, your GP, asthma nurse or hospital doctor will usually keep a close eye on you to monitor any side effects.
If you use preventer medicine, some of the side effects include:
- a sore tongue
- a sore throat
- hoarseness of the voice
- rarely, a mouth infection called thrush
Some people with asthma who take preventer inhalers find that these side effects are less likely if:
- preventer inhalers are used with a spacer
- they rinse their mouth after using a preventer inhaler
There is no overwhelming consensus of evidence that inhaled steroids create a significant risk of causing cataracts or glaucoma. Any increased risk is very small and linked to your age (the older you are, the higher the risk) and the overall dose and length of time you've been taking the steroids. If you're worried, speak to your GP or asthma nurse.
Possible side effects of steroid tablets
Oral steroid treatments do come with possible side effects, like most medication. However the vast majority of people who take oral steroids, especially in the form of short or occasional courses, will not experience significant side effects.
One of the most common side effects from taking a short course of steroid tablets is stomach irritation. Some people find this is less likely if tablets are taken first thing in the morning with meals or after food. You can also ask your GP or asthma nurse if they can prescribe a medicine to help deal with any stomach irritation.
Other possible side effects include:
Lower resistance to infection and longer healing time for cuts and wounds. For a small number of people, taking higher doses of steroids lowers the body's resistance to viruses, such as colds and chickenpox. Catching chickenpox when you're taking steroids can cause you to become really unwell, so if you are taking steroid tablets and you come into contact with somebody who has chickenpox contact your GP or asthma nurse as soon as possible. They may take a blood test to check your immunity to chickenpox. If you aren't immune, you may be given an injection to protect you.
Feeling hungrier than usual. Some people find that taking steroids makes them hungrier than usual which can cause them to eat more and put on weight. Eating a well-balanced diet may help. If you think you're putting on weight, speak to your GP or asthma nurse as soon as possible.
Higher blood pressure. Some people who take a short course of steroids have increased blood pressure. Your GP or asthma nurse will tell you if they want to monitor you regularly.
Mood swings. Some people feel hyped up and have difficulty sleeping. Some people feel symptoms of depression, especially if they're prone to depression.
These effects are usually temporary and will stop once the course of tablets has finished.
If you're worried, tell your GP or asthma nurse straight away because they can discuss solutions with you. If you're worried about giving your child steroid to treat their asthma, you can find some reassuring advice here.
Steroids Fact v Fiction
Will steroids stop my child growing?
The most recent British Thoracic Society/Scottish Intercollegiate Guidelines Network on the management of asthma (that GPs and asthma nurses use) recommends that all children taking inhaled steroids for asthma have their height and weight checked at least annually. There is a small link between inhaled steroids and reduced growth.
What's important to remember is that:
- taking a regular lower dose of steroids in a preventer inhaler to manage their symptoms well can mean your child will need to take fewer steroid tablets overall and lower your child's risk of a potentially life-threatening asthma attack
- children are more likely to be admitted to hospital following an asthma attack if they are not taking their steroids as prescribed
- poorly controlled asthma can itself affect growth
In other words, the benefits far outweigh the risks.
Will steroids affect my bone health?
The use of steroids has been associated with a risk of reduced bone density in some people. Your GP or asthma nurse can talk to you about your individual risk and what measures you can take to reduce this risk at your annual asthma review.
Will steroids make my face fat?
If you're taking steroids, especially if you're taking high doses in the long term, you may gain weight due to increased fluid retention. Some people who take steroids, particularly oral or injected steroids in the long term, may find they put on weight and notice they develop a 'moon-shaped' face. This side effect is usually temporary and will stop once the course has finished. Your GP or asthma nurse will monitor this.
Will steroids cause diabetes?
Diabetes is a condition that causes a person’s blood sugar level to become too high. The use of steroids, especially if you're taking high doses, has been linked to an increased risk of developing a certain form of diabetes. Uncontrolled diabetes can cause serious long-term health problems. Your GP or asthma nurse will keep an eye on your blood sugar levels if you're taking high doses of steroids by arranging blood tests and by testing your urine for glucose. You will be prescribed medicines to help manage your blood sugar levels if you need them.
I'm pregnant. Is it safe to use my preventer inhaler, or take steroid tablets if I need them?
The medicines to treat asthma are safe in pregnancy and won't harm your baby. This includes your preventer inhaler and steroid tablets. There are more risks to both you and your baby if you don't take your medicines and your asthma gets worse. When you first find out you're pregnant book an appointment with your GP or asthma nurse to review your asthma medicines and your written asthma action plan and to check you're taking your inhaler properly. It's also important to see your GP or asthma nurse regularly throughout your pregnancy to make sure your asthma is well managed.
Do I need to carry a steroid card?
Anyone taking oral steroids for more than three weeks should be given a steroid treatment card. Small enough to keep in your purse or wallet, this card has room to record the details of your dose and your condition(s). This is so that if you ever need any medical treatment and you're not able to communicate (you're having an asthma attack, for example), the people treating you know you're taking prednisolone and can plan your treatment accordingly. If you are taking oral steroids, or high-dose inhaled steroids, for more than three weeks then you should never suddenly stop them.
Last reviewed July 2016