Steroids for asthma

Asthma steroids help to calm and prevent inflammation in the airways to keep symptoms under control.

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 and prevent inflammation in your airways by blocking the effects of certain chemicals your immune system uses to kick-start inflammation.
  • Taking steroid medicines makes it less likely that you will experience asthma symptoms such as coughing, wheezing and shortness of breath. It also means you’re less likely to 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.
  • Inhaled steroids are usually in a very low dose and are less likely to cause side effects if the inhaler is used correctly.

Steroids for asthma and their side effects

Asthma 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.

Video: Steroids for asthma and their side effects

Asthma 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.

 

When will your doctor prescribe steroids for your asthma?

“Your doctor will prescribe the lowest dose of steroid medicines you need to fully treat your asthma symptoms and keep you well,” says Dr Andy. “Make sure you go to your asthma reviews regularly to get this dose fine-tuned for you. If you or your child hasn’t had any asthma symptoms for at least three months, your GP or asthma nurse may be able to reduce the medication dose.

“You can reduce the need for larger doses of steroids if you 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 need high doses of steroid tablets in hospital. So even if you’re feeling well, it’s really important to keep taking your preventer inhaler.”

  • Preventer inhalers (usually brown, orange, red, purple or pink) contain a low dose of steroids to soothe your inflamed, sensitive airways over time. This makes them less likely to react when you come into contact with triggers and keeps you symptom-free. Your preventer inhaler contains the lowest dose of steroids possible to help manage your asthma symptoms. If you take it properly and as prescribed it helps to reduce your risk of an asthma attack. This is because it helps get the medicine straight to your lungs so it can work where it’s needed. If you’ve been prescribed a preventer inhaler, you should take it every day as prescribed, even when you’re feeling well. This is so it can build up a protective effect in your lungs over time.
  • Short courses of steroid tablets (called prednisolone) are prescribed to quickly get the swelling in your airways back down again if you have an asthma attack. If you’re getting asthma symptoms even when you’re taking your preventer inhaler as prescribed, a course of steroid tablets may be what you need to get your asthma back under control.
  • Prednisolone can also be prescribed in liquid form and dissolvable tablets. Taking steroids in this way can be useful if you or your child has difficulty swallowing solid tablets. Speak to your GP or asthma nurse to find out more about liquid steroids.
  • A small number of people with severe asthma may be prescribed longer courses of steroid tablets at higher doses. If this is you, please go to our page on using steroids in the long term.

Possible side effects of steroid inhalers – and how to cut your risks 

Steroid inhalers usually have few or no side effects if used at normal doses. However, they can sometimes cause the following side effects:

  • A sore mouth
  • 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 they:

  • Use their preventer inhaler in the correct way as prescribed by their GP or asthma nurse. In this way the steroids in it are unlikely to cause side effects because more of the inhaled medicine goes straight down to the airways where it’s needed. Very little is absorbed into the rest of the body where it could cause side effects. 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. You can find more advice on how to use your inhaler here.
  • Use their preventer inhaler with a spacer. This is because spacers collect the medicine inside them, so they don’t have to worry about pressing the inhaler and breathing in at exactly the same time. This makes a preventer inhaler easier to use and it’s more likely that the medicine will go straight into the lungs where it’s needed. 
  • Rinse their mouth after using a preventer inhaler. This helps to stop any medicine being left behind in their mouth or on their lips. 

  • 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. There’s useful information on how to quit here

Very rarely inhaled steroids can increase the risk of getting cataracts and glaucoma. There’s not enough evidence to suggest that inhaled steroids significantly increase the risk of causing health conditions such as 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. 

There’s also a very small chance that inhaled steroids will affect your child’s growth. “We are talking a centimetre or so here,” says Dr Andy Whittamore. “So I’m pleased to say it really isn’t as scary as some internet articles or chat rooms make out.”

  • It will depend on your child’s age when they start taking steroids, the dose they take and for how long they take them. For example, if a child takes 400mcg of budesonide daily for three years, this translates as a 1.2cm reduction in adult height. This measurement is smaller than your average grape, so it’s a small price to pay for a medicine that can save your child’s life.   
  • “It’s also worthwhile remembering that research shows that poorly controlled asthma can itself affect growth in children,” says Dr Andy. “Ultimately, for children who need them, the benefits of taking inhaled steroids far outweigh the risks.”
  • If you’re worried about you, or your child, taking steroid inhalers, speak to your GP or asthma nurse. For further reassurance and advice, take a look at our page on Common concerns about your child’s medicines
  • 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.

Steroid tablets for asthma

“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 Whittamore. “But if your asthma symptoms do become worse or you have an asthma attack, your GP or asthma nurse may give you a course of steroid tablets. These come as solid tablets or in dissolvable or soluble form, and contain a much higher dose of steroids than a preventer inhaler.” 

The dose and length of the course of steroid tablets you’re prescribed will be tailored to you 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 up to three days.
  • The course may be longer depending on how long it takes you or your child to fully recover.   

Getting the best from your steroid tablets 

“It’s important that steroid tablets are taken as prescribed, that you continue taking your preventer inhaler every day, and that you know the signs that tell you it’s time to talk to your GP again,” says Dr Andy Whittamore.

  • Don’t be tempted to stop taking your steroid tablets before the course is finished. If you don’t finish the course your airways are more likely to still be inflamed and your asthma symptoms may come back again. This means your risk of having a potentially fatal asthma attack will go up. 
  • Make sure you’re fully recovered − this means few or no symptoms of cough, wheeze, tightness in your chest, or difficulty breathing and not needing to use your reliever inhaler (usually blue). If you use a peak flow meter, your peak flow reading should be back to above 75 per cent of your personal best.
  • If you or your child aren’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 or your child finishes 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. 

Taking a longer course of steroid tablets

If you or your child needs 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 or your child to fully recover.

Remember, you should continue using your preventer inhaler daily when taking steroid tablets to help reduce the inflammation in your airways. 

Possible side effects of steroid tablets – and how to cut your risks

Oral steroid treatments do come with possible side effects, like most medicines. Most people who take oral steroids for asthma as short courses occasionally will not experience significant side effects. Although the dose of steroid going into your body is much higher if you’re taking them in tablet form, the side effects are usually temporary and will stop once the course of tablets has finished. If you’re worried, tell your GP or asthma nurse straightaway because they can offer tips on how to reduce side effects.

“If you or your child 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 Whittamore.  

Some of the possible side effects of steroid tablets are:

  • Stomach irritation. This one of the most common side effects from taking a short course of steroid tablets.
    Cut your risk by taking the tablets 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.
  • Lower resistance to infection. 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.
    Cut your risk by contacting your GP or asthma nurse as soon as possible if you come into contact with somebody who has chickenpox while you’re taking steroid tablets. 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. This can cause you to eat more and put on weight.
    Cut your risk by eating a well-balanced diet. You could try the small changes, food swaps and activities plans in the NHS’s Change4Life website for families, or One You for adults. If you think you’re putting on weight, speak to your GP or asthma nurse as soon as possible.
  • Higher blood pressure. 
    Cut your risk by asking your GP or asthma nurse to monitor you regularly.
  • Mood swings and depression. Some people feel hyped up and have difficulty sleeping when taking steroid tablets. Others say they get symptoms of depression, especially if they’re prone to depression. 
    Cut your risk by speaking to your GP about ways to manage low mood, sleeping problems or depression. 

If you’re worried about giving your child steroid tablets to treat their asthma, you can find some reassuring advice here.

“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 Negus, diagnosed with severe asthma

Steroids FAQs

In this section we answer 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 measures you can take 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?

Diabetes is a condition that causes a person’s blood-sugar levels 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 used 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 using 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 or a high dose of inhaled 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 that 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.

Talk to our asthma nurses

Remember, if you have any concerns or are worried about taking oral steroids, you can always call the Asthma UK Helpline on 0300 222 5800 to chat to one of our friendly asthma nurses, or message them via WhatsApp on 07378 606 728 (Monday-Friday, 9am-5pm). To email an asthma nurse, fill in the Helpline Contact Form and you’ll receive a reply within three working days.

 

Last updated June 2019

Next review due June 2022