Lots of people with asthma need to take short courses of steroids - known as oral corticosteroids by healthcare professionals – when their asthma symptoms get worse. But a small number of people with severe asthma need to take higher doses of steroids for longer periods. This may mean months or years. Usually, these will be given as tablets.
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. You’re already taking these steroids at very low doses through your preventer inhaler but some people with severe asthma need the higher dose you can get from tablets to manage their symptoms properly.
So if you’re taking long term steroid tablets for your severe asthma, what does this mean for you?
Our ultimate guide will help you understand clearly the pros and cons, plus the side effects and how to manage them – read on for all the answers.
Who needs long term oral steroids?
Not everyone with severe asthma needs to take them. But if your asthma isn’t controlled with the maximum doses of a preventer inhaler and other add-on treatments, you may need to take steroids in tablet form in the long term. You might take them either continuously or simply have more frequent courses for flare-ups than other people with asthma.
The most commonly prescribed steroid tablet is prednisolone. Your healthcare professional should check your inhaler technique and make sure you’re taking your medicine properly before prescribing steroid tablets. Sometimes, a simple tweak to the way you’re taking your medicine is enough to manage your symptoms without needing steroid tablets.
Why do I still need my preventer inhaler?
Your healthcare professional will keep you on the maximum dose of inhaled steroids while you’re taking steroid tablets. That’s because they’ll be aiming to stop your steroid tablets again as soon as possible, and there’s a higher chance of being able to do this if you carry on using your preventer inhaler.
Research also shows that using your preventer inhaler as directed means you’ll be able to take the lowest possible dose of steroid tablets, which reduces your risk of having side effects. So it’s important you continue using your preventer inhaler as prescribed.
What dose will I be given?
Your healthcare professional will always try to manage your asthma using the lowest possible dose. As steroid tablets can have side effects when you take them in the long term, your healthcare professional may prescribe other medicines – known as ‘steroid-sparing’ treatments – to help prevent you needing them altogether, or to keep the dose as low as possible and reduce the risk of side effects.
Will I always have to take steroid tablets?
Even if you have to take steroid tablets for a few weeks or months, this doesn’t necessarily mean you’ll always need them - the aim is to stop the tablets altogether, if possible. Your healthcare professional will consider assessing you for other treatments such as bronchial thermoplasty, Xolair and other medicines in the new class of ‘mab’ drugs with you – these treatments can stop you needing to take steroid tablets so often, and at such high doses. If your asthma’s controlled, you’ll be gradually taken off the tablets. You should never stop taking them suddenly as your asthma symptoms may get worse.
Your healthcare professional will try other treatments first but there is also a steroid medicine called Kenalog (triamcinolone) that is occasionally prescribed – there’s some evidence it may be more effective than oral steroids if your asthma is very severe and difficult to control.
The steroid medicine will be injected by a nurse, usually into your buttock, and you’ll be given the injections at intervals decided by your specialist. 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. You are more likely to have some side effects when you’re on long term steroid tablets, compared to people who only take a short course when their symptoms get worse. If you take steroids in tablet form for three months or more continuously, or you have three to four courses a year, you’ll be at higher risk.
It can be worrying to think about taking medicine that causes side effects but remember your healthcare professional will only prescribe steroid tablets when they’re essential to stop you having life-threatening asthma attacks and serious symptoms. They will aim to take you off them again if possible, although some people do need to take them indefinitely.
But not everyone who takes long term steroid tablets experiences side effects. Everyone’s different, so just because you’ve read about people having side effects, it doesn’t mean you will too. And you’re unlikely to experience all of the potential side effects. It’s also 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.
Below are the side effects you may experience if you take steroid tablets for more than three months or have three to four courses a year – and some simple ways to manage them:
- Increased appetite. This can lead to weight gain if you end up eating more as a result. If you think you're putting on weight, speak to your GP or asthma nurse as soon as possible – they will be able to work with you and your personal circumstances to help you get a realistic plan in place for healthy eating and activity.
- 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. Some vaccinations aren’t suitable for people taking steroid tablets because lowered immunity can mean they may make you unwell. Remind your healthcare professional you take steroid tablets if you’re due any vaccinations.
Washing your hands regularly, getting plenty of sleep and eating a balanced diet can help reduce your chances of catching colds and flu. Catching chickenpox when you're taking steroids can cause you to become really unwell. If 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. 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.
- A puffy ‘moon face’ and swollen ankles caused by high levels of the hormone cortisol as a result of taking long term steroids.Speak to your healthcare professional if this is troubling you. They may be able to help you weigh up the advantages of your treatment against these side effects, or refer you for a talking therapy to discuss any effects on your self-esteem.
- 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. Reducing your salt intake, keeping your weight down, eating a diet high in fruit and vegetables and keeping your alcohol intake within safe limits will all help to cut your risk.
- Mood swings. 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. For more sleep tips, visit the NHS site.
- Stomach ulcers – you might 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.
- Adrenal insufficiency. Rarely, your adrenal glands may stop working well by themselves. These glands produce various hormones, including the hormones 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 cortisol. 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 steroids, to check whether you’re affected.
If you take steroid tablets for many years, you may be at raised risk of the following:
- Weakening of the bones, or osteoporosis, can be a longer term risk. Your healthcare professional may suggest a bone mineral density scan to assess your risk, and might 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 reduce your risk.
- Diabetes – or worsening of existing type 1 or type 2 diabetes. This is because steroids can affect the way your body controls blood sugar levels. The effect may be reversed once you stop taking steroids. Keeping to a healthy weight, not smoking, having a balanced diet and being as active as possible can all help reduce your risk of diabetes – and may help you manage asthma symptoms too. Your healthcare team can monitor your blood sugar levels.
Lots of people taking long term steroid tablets worry about side effects, so if you’re concerned, you’re not alone. What’s important is that you don’t stop taking them unless you’ve agreed this with your healthcare professional, as this can mean your asthma gets worse again, which could result in a potentially life-threatening asthma attack.
Talk to your healthcare professional about your worries, whether you’ve noticed some side effects or you’re wondering whether you may experience some in the longer term. They may be able to help you manage side effects, or reduce your risk of having them.
It’s also worth remembering that your healthcare professional will keep you on the lowest possible dose of steroid tablets to manage your asthma, which will help minimise the chances of having side effects.
If you have any questions or concerns, please call our Helpline on 0300 222 5800 (Mon - Fri; 9am - 5pm) to speak to one of our friendly asthma nurses.
How to worry less
“I’ve come to realise that even though I’m getting side effects from taking steroids, 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.” - Nichola Duane, 39
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. If you find this hard, consider what your child, partner or a friend might say to you. They might say that knowing you’re taking your medicine stops them worrying so much about your asthma. Or they might point out some of the things you can do because your asthma is better managed now. 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.
Read our other tips for dealing with concerns about your medicines.
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.
Last updated September 2016
Next review due September 2019