Steroid tablets for troublesome symptoms

Steroid tablets may be required in severe asthma attacks, or for exacerbations of chronic obstructive pulmonary disease (COPD), usually for a short course of several days or weeks. However, some people may require long term use of steroid tablets. Long term use carries a risk of side effects, so following your self management plan and doctor's advice is important in minimising these. If taken long term, steroid tablets must be reduced slowly, rather than being stopped suddenly.

What are steroids?

The adrenal gland in our body produces a steroid naturally every day called cortisol. Cortisol is involved in a variety of activities including production of glucose, which is the body’s energy source, helping maintain salt and water balance, and working with the body’s immune system. Steroid tablets are a man-made version of the body’s natural cortisol.

The steroids used to treat airways disease are very different to those taken by some athletes to boost their strength (those are called 'anabolic steroids' and have different effects on the body).

The steroid most commonly used in adults is called prednisone. For small children and people who cannot take tablets, a liquid form of prednisone is available.

When do I use steroid tablets?

You may be prescribed oral steroid tablets for an acute asthma attack as they work quickly to treat the inflammation in the airways. If you have chronic obstructive pulmonary disease (COPD) you may be prescribed steroid tablets short-term to treat exacerbations.

Occasionally asthma or COPD symptoms may be so severe and persistent, despite inhaled corticosteroid (preventer) therapy, people may be advised by their respiratory specialist to use steroid tablets continuously (every day or on alternate days) to help with their symptoms.

What are the side effects of steroid tablets?

When steroid tablets are taken in short bursts (one or two weeks) there are usually no long term side effects. Sometimes you may experience an increased appetite, a change in your mood (a high mood more often than a depressed one), indigestion/heartburn and occasionally fluid retention.

Side effects are much more likely with longer courses and high doses. The main ones are:

• easy bruising, skin thinning and slow healing of cuts or wounds
• elevated or depressed mood
• increased susceptibility to infection
• fluid retention with swelling of the ankles
• puffiness or roundness of the face (moon face)
• thinning of the bones (osteoporosis) which, if severe, may lead to a greater risk of fractures if you fall
• development of increased blood glucose levels and diabetes
• slowing of growth in children
• cataracts in the eyes
• adrenal gland suppression.

Ways to help prevent side effects

Follow treatment plans

Help reduce the need for steroid tablets:

• Stay well: Take your inhaled respiratory medications regularly and as prescribed by your doctor.
• Use your inhalers correctly. Ask your doctor, nurse, pharmacist or asthma educator to check your inhaler technique.
• Follow your self management plan, measure your peak flow when necessary and start treatment as directed in your plan early. Ensure your self management plan is regularly updated, particularly after you have had an asthma attack or a chest infection.

Watch timing of dose

The timing of steroid tablet doses:

• Take the daily steroid dose in the morning. Morning is the time the body normally produces cortisol for the day so you will mimic what happens naturally in the body and this will help minimise side effects.
• Take the dose during or after meals to reduce heartburn and indigestion.
• Ask your doctor if it is appropriate for you to take the steroid tablets every other day, instead of each day.

Weight control

Aim to avoid weight gain:

• keep up your daily exercise routine
• eat three average-sized meals a day
• try not to snack in-between meals
• include foods that are high in fibre (vegetables, fruit, wholegrain breads and cereals)
• avoid foods containing large amounts of fat, especially takeaways and fried foods
• avoid foods such as cake, biscuits and soft drinks because they are high in sugar
• drink plenty of fluids such as water. Avoid alcohol, which is full of calories
• eat a wide variety of foods including fruit, vegetables and cereals for daily vitamin and mineral requirements.

Also see: Healthy eating - simple rules

Minimise effect on bones

Long-term steroid tablet treatment can weaken bones. This can't be completely prevented, but can be reduced if you:

• stay as fit and active as possible
• have weight-bearing exercise, like walking, which helps maintain bone strength
• eat and drink calcium-rich foods, for example, cheese, yoghurt and milk
• ask your doctor if you might benefit from taking a calcium supplement or a medication to help keep your bones strong.

What happens if I stop long-term steroid treatment?

Because your body’s own natural steroid production may be switched off when you take steroid tablets for longer than two to three weeks, it may take a while to start again after you have stopped your tablets (adrenal gland suppression). This can be dangerous if the body finds itself seriously short of steroids when it is needed in situations like acute illness or after an accident.

When long-term treatment is to be stopped, the dose must be decreased very gradually and only on the advice of your doctor. The dose reduction may occur over several weeks or months. This allows the body time to start making natural steroids again.

Anyone taking regular oral steroid medication should wear a Medic-Alert bracelet, so that in the event of an accident or an acute illness the doctor can provide extra steroids if needed.

Related topics

Also see: Keeping your asthma under control and Asthma medicines and COPD medicines

Original material provided by the Asthma Foundation of New Zealand, 2010. Edited by everybody, December 2010.