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 the 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.
Steroids can be prescribed in inhaler, tablet or liquid form
- Preventer inhalers (usually brown, orange, red, purple or pink) contain a low dose of steroids to help you or your child manage asthma symptoms over time.
- Short courses of steroid tablets (called prednisolone) are prescribed to treat acute asthma attacks and help reduce inflammation in the airways when a preventer inhaler is no longer effective. If you’re getting asthma symptoms whilst 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.
Your preventer inhaler taken every day contains the lowest dose of steroids possible to help manage your asthma symptoms. If you take it properly and regularly as prescribed (usually twice a day) 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 to prevent and reduce the swelling and inflammation in your airways.
If you’ve been prescribed a preventer inhaler, you should take it every day, even when you’re feeling well. This is so it can build up a protective effect in your lungs over time. The low dose of steroids helps to reduce your sensitivity to triggers and keep you symptom-free.
Possible side effects of steroid 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 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.
If you or your child uses preventer medicine, some of the side effects that could occur include:
- a sore tongue
- a sore throat
- hoarseness of the voice
- rarely, a mouth infection called thrush
- for children, a very small chance of reduction in adult height
Some people with asthma who take preventer inhalers find that side effects are less likely if:
- preventer inhalers are used with a spacer. This is because spacers collect the medicine inside them, so you don’t have to worry about pressing the inhaler and breathing in at exactly the same time. This makes a prevent inhaler easier to use and it’s more likely that the medicine will go straight into your lungs where it’s needed.
- rinsing their mouth after using a preventer inhaler. This helps to stop any medicine being left behind in the mouth or on the lips.
There’s not enough evidence to suggest that inhaled steroids 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 a child’s growth. Clinically this height reduction is described as ‘insignificant’, and it will depend on the 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 400 mcg 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. Ultimately, for children who need them, the benefits of taking inhaled steroids far outweigh the risks.
“I’m not particularly concerned about the asthma medicines my son takes. I know some people might be concerned about their child taking steroids, and the influence they could have on their child’s height as they get older, but I’d rather Ellis takes his medicine that could save his life, and risk him being 1cm shorter.” – Sharon Woodward, mum to Ellis, 3.
If you're worried about you, or your child, taking steroid inhalers, speak to your GP or asthma nurse. You can also call our Helpline on 0300 222 5800 (Mon to Fri; 9am to 5pm) to speak to one of our asthma nurses. For further reassurance and advice, take a look at our page on Common concerns about your child’s medicines.
If you’ve been prescribed a preventer inhaler and are using it correctly, you’re less likely to need to take steroid tablets. But 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. These come 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 depend on your age, how you respond to the treatment 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 is important that steroid tablets are taken as prescribed and that you continue taking your preventer inhaler every day. You should also make sure that you don't stop taking your steroid tablets before the course is finished or you're fully recovered. 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. This means your risk of having a potentially fatal asthma attack will go up.
How to know when you’re ‘fully recovered’:
- Having few or no symptoms of cough, wheeze, tightness in the chest, or difficulty breathing
- Not needing to use 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. A longer course of steroid tablets may be needed to get yours/their asthma back under control, and 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.
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 a 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 or asthma specialist.
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 of steroid tablets, will not experience significant 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.
Some of the possible side effects of steroid tablets are:
- Stomach irritation is one of the most common side effects from taking a short course of steroid tablets. Some people find this is less likely if they take 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 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 when taking steroid tablets. Others say they get symptoms of depression, especially if they're prone to depression.
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 straight away because they can discuss solutions with you. You can also call our Helpline to chat to one of our friendly asthma nurses on 0300 222 5800 (Mon to Fri; 9am to 5pm), who will be able to offer tips on how to reduce side effects.
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. Probably like most people 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.
Is it possible to lower the risk of side effects from steroids?
There’s always a risk of side effects when taking any prescription drug, but there are ways you can lower the risk when taking oral steroids for asthma:
- 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 could result in you needing high doses of steroids in the form of tablets or an IV drip in hospital. So even if you're feeling well, it's really important to keep taking your preventer inhaler.
- Make sure you know how to take your preventer inhaler correctly. Incorrect inhaler technique 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. If you’re unsure about how to use your inhaler correctly, ask your GP or asthma nurse to show you the technique at your next asthma review.
- Take your steroid tablets as prescribed and finish the course. If your GP or asthma nurse thinks you need a course of steroid tablets, you need to take them exactly as prescroned and continue taking them until you 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. A large dose could increase your risk of getting side effects.
- 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 can have your dose of steroid inhaler stepped down. So if you’ve given up smoking and your asthma has been well controlled for three months, make an appointment with your GP or asthma nurse to review your treatment. 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 of steroids. There's useful information on how to quit here.
- Make sure you go to an annual asthma review (every six months for children) where you can check with your GP or asthma nurse that you're taking the right medication at the correct dose, in the right way. Your community pharmacist may also be able to advise you on your medications and check your inhaler technique. 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 (step down) the medication dose.
In this section we answer your common concerns about taking steroids
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. Although there’s a small link between inhaled steroids and reduced growth, the benefits of your child using a preventer inhaler far outweigh the risks.
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
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?
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 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 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.
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 (Mon to Fri; 9am to 5pm) to speak to one of our friendly asthma nurses. To email an asthma nurse, fill in the Helpline Contact Form and you’ll receive a reply within five working days.
Last reviewed August 2016.