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People who have been diagnosed with severe asthma are more likely to be taking oral corticosteroids, or steroid tablets, to control asthma symptoms and reduce the risk of an asthma attack. The steroid tablet usually prescribed is Prednisolone. Studies have shown that this is the most effective steroid for severe asthma.
Corticosteroids are copies of hormones your body produces naturally. They help to calm inflamed airways and stop inflammation by blocking the effects of some chemicals your immune system produces. This helps ease asthma symptoms such as breathlessness and coughing and will also help prevent your lungs reacting to triggers. People with severe asthma have high levels of inflammation and their asthma is not controlled by the usual treatments so they need to take higher doses of steroids for months or even years.
They are most likely to be prescribed for you if:
- Your asthma isn’t controlled with the maximum doses of a preventer inhaler and other add-on treatments
- You are having repeated asthma attacks.
What dose will I be given?
Your healthcare professional will always try to manage your asthma using the lowest possible dose. Everyone is individual and will need to be prescribed the dose best suited to them. Your healthcare professional will work with you to see how well you can manage your symptoms at lower doses and only increase them if the symptoms are still causing problems.
Will I always have to take steroid tablets?
People with severe asthma are often taking steroids for many years but new treatments for some types of severe asthma, known as monoclonal antibodies or biologics, have cut down the need for high doses of steroids. In some cases people with severe asthma have been able to stop taking steroids completely.
Even if you have to take steroid tablets for a few weeks or months, this doesn’t mean you’ll always need them – your healthcare professional will work with you and keep checking to make sure you have the lowest dose possible that works for you.
Your healthcare professional will consider referring you to a Specialist Asthma Clinic where you can be assessed for other treatments such as bronchial thermoplasty and biologic therapies. Biologics are a group of drugs called monoclonal antibodies (mAbs). These treatments can stop you needing to take steroid tablets so often or at high doses. If your asthma is getting controlled, you’ll be gradually taken off the steroid tablets but you should never stop taking them without advice as your asthma symptoms may get worse.
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.
What’s key is that you keep talking to your healthcare team about your symptoms and what does and doesn’t help, as they may be able to suggest other options.
Like all medicines, steroid tablets come with a risk of side effects, and some of them may be serious. In a study of 808 people with severe asthma, it was found that 93% of them had one or more condition linked to the use of steroid tablets.
It can be worrying to think about taking medicine that may cause side effects, but your healthcare professional will only prescribe steroid tablets when they’re essential to stop you having life-threatening asthma attacks and serious symptoms.
You are more likely to have some side effects when you’re on long-term steroid tablets, compared with people who only take a short course when their symptoms get worse. If you take steroid tablets for three months or more continuously, or you have three to four courses a year, you’ll be at higher risk.
But not everyone who takes long-term steroid tablets have serious side effects. Everyone’s different, so just because you’ve read about people having a particular side effect, it doesn’t mean you will, too. And you’re unlikely to experience all of the possible side effects.
It’s important to know that most of the common ones will stop when you finish taking the tablets. Even if you do get some side effects, there are often ways to reduce them.
This can lead to weight gain as you end up eating more as a result. If you think you’re putting on weight, make an appointment with your GP or asthma nurse – they can help direct you to people who can help with managing your weight. You could try the small changes, food swaps and activities plans on the NHS’s Change4Life advice site for families, or One You for adults.
Lower resistance to infection means it can take longer for cuts and wounds to heal. For a small number of people, taking higher doses of steroid tablets lowers the body’s resistance to viruses, such as colds and chickenpox. Live vaccinations aren’t suitable for people taking steroid tablets because of lowered immunity and the risk of serious infections. If you are due any vaccinations make sure you tell your healthcare professional you take steroids.
You should also speak to your GP or asthma nurse if you come into contact with someone who has shingles, if you’ve never had chickenpox, or you’re not sure whether you’ve had it. Shingles is a reactivation of the chickenpox virus and it can’t be caught – but if someone who’s never had chickenpox comes into close contact with shingles, they may catch chickenpox.
Puffy 'moon face'
This is caused by high levels of the hormone cortisol as a result of taking long-term steroid tablets. If this is troubling you speak to your healthcare professional. They may be able to help you weigh up the advantages of your treatment against these side effects or refer you for talking therapy to discuss any effects on how you’re feeling about yourself.
Higher blood pressure
Some people who take a short course of steroid tablets have increased blood pressure. Your GP or asthma nurse will tell you if they want to monitor you regularly. Reducing your salt intake, keeping your weight down, eating a diet high in fruit and vegetables and keeping your alcohol intake within recommended limits will all help to cut your risk.
Some people feel hyped up and have difficulty sleeping. Others experience low mood, especially if they’re prone to depression. Speak to your GP about ways to manage low mood or sleeping problems. They’ll have lots of suggestions, which may include having a regular bedtime routine to help you relax and fall asleep more quickly. They can also refer you for counselling if necessary. The NHS also has information on getting to sleep.
You may be put on medicines to reduce your risk. Smoking raises your risk of stomach ulcers, so if you smoke, quit. While it was once thought that alcohol, spicy foods and stress could cause ulcers, there’s actually little evidence for this – but they may make ulcers worse if you already have them.
Rarely, your adrenal glands may stop working well by themselves. These glands produce various hormones, including adrenaline and cortisol, and are just above your kidneys. This can mean that when you stop taking steroid tablets, your body doesn’t produce enough of its own natural steroids. This can cause symptoms such as weight loss and fatigue. In most cases, adrenal insufficiency will correct itself in time. Your doctor will monitor you when you’re taken off steroid tablets, to check whether you’re affected.
Glaucoma and cataracts
Some people taking steroid tablets experience eye problems such as glaucoma (when your optic nerve becomes damaged due to a build-up of fluid in your eye) and cataracts (when the lens in your eye develops cloudy patches).
Glaucoma can lead to loss of vision if it isn’t diagnosed and treated early. The treatment will depend on the type of glaucoma you have, but you may be prescribed eye drops to reduce the pressure in your eyes, or sometimes be offered laser treatment or surgery.
If your cataracts aren’t too bad, stronger glasses and brighter reading lights may help for a while. However, because cataracts get worse over time, you’ll eventually need surgery to remove and replace the affected lens.
If you get a bruise treat it by cooling the area with a cold compress (a flannel or cloth soaked in cold water) or an ice pack wrapped in a towel, holding it over the area for at least 10 minutes. Do not put the ice pack straight onto your skin as this will be too cold and could be painful.
Weakening of the bones, or osteoporosis
The risk of osteoporosis is much higher If you take steroids over a period of years. Your healthcare professional may suggest a bone mineral density scan to assess your risk and may recommend some supplements or medicine to prevent or treat osteoporosis. Taking regular exercise and having a diet high in calcium-rich foods, such as dairy, dried fruit and leafy green vegetables, can all help to reduce your risk.
Steroids can affect the way the body controls blood sugar levels and this can lead to diabetes. And if you already have diabetes steroids can make it worse. But these effects may be reversed once you stop taking steroids. Your healthcare professional can monitor your blood sugar levels and your diabetes medicines if you are taking any.
Keeping as close to a healthy weight as possible, not smoking, having a balanced diet and staying active, can help reduce your risk of diabetes. And these are all things that will help you manage your asthma symptoms too.
Even if you are concerned about side effects, it is important that you don’t stop taking your medicines unless this is agreed with your healthcare professional. If you stop taking them on your own it can mean your asthma symptoms getting worse and even a life-threatening asthma attack.
It’s estimated that around half the people with severe asthma don’t take their steroid tablets exactly as prescribed. Talk to your healthcare professional about your worries if you’ve noticed some side effects or you’re wondering if you may experience them in the future.
Remember that you’ll be kept on the lowest possible dose of steroid tablets to manage your asthma, which will help minimise the chances of having side effects.
I’ve come to realise that even though I’m getting side effects from taking steroid tablets, my asthma medicines are keeping me out of hospital so it’s worth it. The side effects don’t outweigh the benefits quite yet and there are ways to get them under control.
It can be really useful to write a pros and cons list to help you see clearly whether the benefits of steroid tablets outweigh the problems for you. Start by making a list of the things that worry you – the cons – for example, weight gain.
Now have a think about the pros, such as being able to do things because your asthma is being controlled.
Once you can pinpoint what your particular worries are, you can talk to your GP or asthma nurse to put your mind at rest or ask them for advice on how to tackle your concerns.
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 will know you’re taking steroid tablets and can plan your treatment accordingly.
If you are taking steroid tablets, or high-dose inhaled steroids, for more than three weeks then you should never suddenly stop them.
If you have any questions or concerns, please call our Helpline on 0300 222 5800 (Monday-Friday, 9am-5pm) to speak to one of our friendly asthma nurses.
Last updated February 2020
Next review due February 2022