- How do steroids help asthma?
- Video: Steroids for asthma and their side effects
- When will your doctor prescribe steroids for your asthma?
- Steroid preventer inhalers for asthma
- Steroid tablets for asthma
- Getting the best from your steroid tablets
- Side effects of steroids
- Steroids FAQs
- Talk to our asthma nurses
The steroids used to treat asthma are known as corticosteroids. Corticosteroids are copies of hormones your body produces naturally.
Steroids help asthma by calming inflamed airways and stopping inflammation. This helps ease asthma symptoms such as breathlessness and coughing. It will also help prevent your lungs reacting to triggers.
“You’re more likely to avoid high doses of steroids if you take your preventer inhaler every day as prescribed,” says Dr Andy Whittamore, Asthma UK’s in-house GP.
Video: Steroids for asthma and their side effectsAsthma + Lung UK’s in-house GP Dr Andy Whittamore explains how steroids work to help control asthma and why you shouldn’t worry about side effects.
Transcript for steroids for asthma and their side effects
0:00 As a GP, I do get people coming to see me worried about taking steroids for their asthma.
0:06 I do reassure them that the low doses we prescribe in inhalers is usually enough to control their asthma
0:13 without causing any major problems.
0:15 So they're very safe, and trust me that they're the most effective thing we have. Steroids work by calming down the
0:22 inflammation in the lungs. It's that inflammation that not only causes symptoms such as cough, wheeze and
0:28 breathlessness, but it's also inflammation that really gets flared up by pollens, pollution, stress, exercise, things like
0:36 that. So, by treating that underlying inflammation with a low-dose steroid inhaler, what we can do is help prevent people having symptoms and massive
0:46 flare-ups that end up with them being in hospital. If you need steroid tablets, whether they're on a short-term basis or a very occasionally long-term, it's again to treat the inflammation in the lungs, it's just is having to treat a lot more
1:00 inflammation to try and keep you safe, and keep you well. For people who are
1:05 taking an inhaled steroid, so the brown preventer medication, for example, I do reassure them the low doses generally don't cause a problem, but if they do get
1:14 problems, for example with the sore mouth, then to rinse their mouth out after they use their inhaler, to help prevent this, but if it's still causing a problem then to speak to their GP or nurse about
1:24 different medications. Finally, the key thing is that steroid treatment is essential in the management of asthma.
1:31 Taking a regular preventative containing steroid can keep your lungs well, can keep you healthy and keep you doing the things that you enjoy doing.
Your doctor will prescribe steroids for your asthma if you need extra help with symptoms. They’ll prescribe the lowest dose of steroid medicines you need to treat your asthma symptoms and keep you well.
For example, your GP will prescribe steroid medicine if:
- you’re taking your reliever inhaler three or more times a week. Most people with asthma are prescribed a steroid preventer inhaler to use every day. It stops inflammation building up in your airways and cuts your risk of symptoms. So, if you’ve only been given a reliever inhaler, and you’re using it three or more times a week, see your GP.
- you’ve had an asthma attack. You might be given a short course of steroid tablets (prednisolone) to take until your symptoms are fully under control. These can quickly get the swelling in your airways back down again if you have an asthma attack.
- you’re getting asthma symptoms even when you’re taking your preventer inhaler as prescribed. This is when a course of steroid tablets may be what you need to get your asthma back under control.
- you have severe asthma. Some people with severe asthma are prescribed a longer course of steroid tablets at higher doses.
If your asthma is still not well controlled in spite of high dose inhaled steroids, keep taking them until you can discuss your treatment with your GP. Use our severe asthma tool to find out if you need a referral to a severe asthma specialist.
Preventer inhalers contain a low dose of steroids to prevent inflammation in your airways over time. This means you’re less likely to react to your asthma triggers.
“If you’ve been prescribed a preventer inhaler and are using it correctly, you’re less likely to need to take steroid tablets,” says Dr Andy. “Also, 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.”
Your steroid preventer inhaler is an essential part of your asthma care. It lowers your risk of symptoms and an asthma attack. You need to take it every day as prescribed, even if you feel well, to keep your airways protected. This is because it works away in the background to prevent inflammation building up in your airways. If you stop taking it that protection will stop.
Don’t stop taking your steroid preventer inhaler before speaking to your GP or asthma nurse. You need your preventer every day to keep the inflammation down in your airways and lower your risk of an asthma attack.
“If you’re on a high dose, your body can really miss it if you stop it suddenly,” says Dr Andy.
“Always talk to your GP first before stopping any medicine they have prescribed. And remember to collect your repeat prescription before your inhaler runs out.”
Steroid tablets also come in a soluble or liquid form. They contain a higher dose of steroids than a preventer inhaler.
Your GP will work out how much you need to take, and for how long, depending on your symptoms and how long it takes you to recover.
- For adults, steroid tablets are usually prescribed for at least five days.
- For children, steroid tablets are usually prescribed for at least three days.
- If you need a longer course of steroid tablets, your GP or asthma nurse will make sure these are prescribed at the lowest possible dose. You may need to take them for weeks or a few months at a time, depending on the number of steroid tablets you’re prescribed, or how long it takes you to fully recover.
“Your course of steroids may be longer depending on how long it takes you or your child to fully recover,” says Dr Andy. “It’s important that you come off them gradually if you’ve taken them for three weeks or more.”
“It’s important that steroid tablets are taken as prescribed, and that you see the course out,” says Dr Andy.
“You also need to carry on with your preventer inhaler so you can benefit from a lower dose of steroid tablets and give yourself more chance of a quick recovery.”
As well as this:
- Don’t be tempted to stop taking your steroid tablets before the course is finished. If you don’t finish the course your airways may still be inflamed. This means your asthma symptoms could come back again, putting you at risk of what could be a life-threatening asthma attack. Your GP can support you in coming off steroids gradually to cut your risk of symptoms
- Make sure you’re fully recovered.This means few, or no, symptoms (cough, wheeze, tightness in your chest, difficulty breathing) and not needing to use your reliever inhaler.“If you use a peak flow meter and your reading is back to above 75% of your personal best, that’s a good indication you’ve recovered too,” says Dr Andy.
- If you haven't fully recovered, see your GP as soon as possible as you may need another course of steroid tablets to get the inflammation in your airways right down. It should be started as soon as you finish the first course – or as soon as possible. This is to make sure the inflammation in your lungs, which the steroid tablets are helping to control, doesn’t build back up again.
- Make sure your GP knows about other conditions you have like high blood pressure, stomach ulcer or diabetes. And any other other medicines you’re taking, like aspirin, ibuprofen or anti-coagulants, which could react with the oral steroids.
Like all prescription drugs, there is a risk of side effects when you take steroids. But your GP will only ever prescribe them if the benefits outweigh the risks.
It’s also worth remembering that you’ll be kept on the lowest possible dose of steroids to manage your asthma, which will help minimise the chances of having side effects.
Side effects from your steroid preventer inhaler
Inhaled steroids (the ones found in your preventer inhaler) are usually in a very low dose and have few or no side effects. However, they can sometimes cause side effects like a sore throat or thrush.
“Using your inhaler in the best way, with a spacer, and rinsing your mouth out, cuts your risk of side effects - the steroid medicine you’re inhaling goes straight down into the airways and very little is absorbed into the rest of the body,” says Dr Andy. “If you’re taking a higher dose your GP or asthma nurse will keep a closer eye on you to monitor side effects.”
Side effects from a short course of steroid tablets
Most people who take a short course of oral steroids won’t experience significant side effects. You’re more likely to notice side effects if you’re on a high dose.
Although the dose of steroid going into your body is higher if you’re taking them in tablet form, any side effects like stomach upset, increased appetite, and mood swings are usually temporary and will stop once the course of tablets has finished.
Taking steroid tablets can also mean you’re more at risk from colds and viruses.
"Catching chickenpox when you’re taking steroids can cause you to become really unwell,” says Dr Andy. “If you’ve been around someone with chickenpox, see your GP to check your immunity.”
If you’re worried about any side effects, tell your GP or asthma nurse as soon as possible. They can give advice on how to reduce them. For example, if your stomach is upset after taking steroids, your GP may suggest taking the tablet with meals or after food.
“If you do get side effects from taking steroid tablets, it’s important to remember that the benefits far outweigh the risks, and your GP or asthma nurse will aim to get you on the lowest doses that will completely control your symptoms,” says Dr Andy.
Side effects from taking steroid tablets longer-term
If you take steroid tablets for three months or more continuously, or you have three to four courses a year, you’re more likely to get side effects.
These can include risk of infection, increased appetite, higher blood pressure, mood swings and depression.
“I’ve been taking steroid tablets for severe asthma for 11 years. I used to hate taking them and a few years ago decided to stop all my medication. I was in hospital 36 hours later. Even though the high dose of steroids I take causes some side effects, without them I wouldn’t breathe as well or have such a good quality of life. You need to balance it up.” – Jenny, diagnosed with severe asthma
Never stop taking your steroid medicines suddenly. Keep taking the course as prescribed, and talk to your GP about any side effects you're worried about.
Side effects for your child with asthma
If you’re worried about your child taking steroid inhalers, or side effects from steroid tablets, speak to your GP or asthma nurse. You can also get some advice and reassurance about Common concerns about your child’s medicines.
In this section we answer some of your common concerns about taking steroids.
Will steroids affect my bone health?
The use of steroids has been associated with a risk of reduced bone density in some people. At your annual asthma review, your GP or asthma nurse can talk to you about your individual risk and what you can do to reduce this risk.
Will steroids make my face fat?
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?
The use of steroids, especially if you’re taking high doses, has been linked to an increased risk of developing diabetes.
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.
I’m pregnant. Is it safe to use my preventer inhaler, or take steroid tablets if I need them?
The medicines used to treat asthma are generally 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.
Do I need to carry a steroid emergency card?
Some people who take medicines containing steroids may need a steroid emergency card. It depends on what total daily dose of steroid medicine you’re taking, and for how long.
For example, your doctor may ask you to carry a steroid card if:
- you need oral steroids (for example prednisolone) for longer than four weeks
- you’ve needed several short courses of oral steroids in a year
- your preventer inhaler contains high doses of steroid medicine. Different preventer inhalers have different doses that are considered high, so you need to check with your GP or asthma nurse and pharmacist if you’re not sure.
- you’re taking other types of steroid medicine, for example steroid nasal drops or steroid creams, alongside your steroid inhaler, which could add up to a high overall dose.
A steroid emergency card lets health care professionals and emergency doctors know you take steroids. It is useful in emergency situations. This is because when you’re on high doses of steroids your body may stop producing enough of its own natural steroids to deal with illness or injury. In this situation, doctors will need to give you extra corticosteroids.
At your next appointment, ask your doctor or asthma nurse what your total daily dose of steroid medicine is, from your preventer medicine, and any other steroid medicines you’re taking. They can let you know if you should be carrying a steroid card.
If you do need a steroid card, make sure you always carry it with you. If you lose it, you can get a replacement from your pharmacy or GP.
Do not stop steroids suddenly
If you’ve been prescribed steroids, whether as tablets, liquid or in an inhaler, make sure you take them every day as prescribed. Do not stop taking your steroid medication suddenly unless you have been told to by your GP or asthma nurse.
If you have any concerns or are worried about taking steroids, you can call the Asthma UK Helpline on 0300 222 5800 to talk to one of our respiratory nurse specialists. You can also message them via WhatsApp on 07378 606 728 (Monday-Friday, 9am-5pm).
Last updated August 2019
Next review due August 2022