Steroids tablets for troublesome asthma

A lot of people are accustomed to taking steroid tablets for attacks of asthma, the courses lasting just a few days or weeks. Some individuals, though, have asthma that causes problems all the time, despite looking after themselves well and using their inhalers properly. These people may need to use steroid tablets continuously (every day or on alternate days) to control their asthma.

Before deciding on long-term steroid treatment, your doctor will probably want the opinion of a chest specialist to make sure all other possible treatments have been explored.

The most commonly prescribed steroid treatment in New Zealand is prednisone (although other drugs are also available). The dose prescribed varies a lot depending on the person. The doctor will work with you to bring the dose down to the lowest possible amount to reduce the likelihood of side effects.

What are the side effects?

When steroid tablets are taken for short periods (under about three weeks), there are usually no problems. However, you may have increased appetite or mood changes (a high mood more often than a depressed one). Occasionally some people suffer from fluid retention and indigestion.

More unwanted side effects happen the longer you take the steroid and the higher the dose. The main ones are:

• increased appetite and weight gain
• thinning of the bones, which can lead to bone fractures if very severe
• slowing of growth in children
• the body's own natural production of the steroid cortisol is reduced; this can be a problem when steroid tablets are stopped or when the body needs a surge of more steroid to cope with an acute illness
• easy bruising of the skin and slow healing of cuts
• puffiness or roundness of the face
• indigestion or stomach ulcers
• fluid retention with swelling of the ankles
• cataracts in the eyes.

How do I prevent steroid side effects

• keep the steroid dose down.

 You can help keep the dose down by:

• taking your other asthma medicines as usual
• using your inhaler correctly - ask someone to check your technique and if an alternative device or a spacer could be of help
• measuring your peak flow every day, and follow a self management plan, starting extra treatment early
• letting the doctor know if your peak flow reading drops or you feel unwell.

Consider when you take the steroids

When and how often steroid tablets are taken can also influence side effects. Fewer side effects occur if:

• the steroid tablets can be taken every other day, instead of each day (even if a slightly bigger dose is needed to keep the asthma under control)
• the daily dose is taken as a single dose in the morning. Morning is the time the body normally produces its cortisone for the day
• take during or after meals.

How do I avoid gaining weight while I am on steroids?

You put on weight when energy taken into the body (in food and drink) is greater than the energy the body uses (in exercise). Aim to keep your weight down by keeping to sensible eating habits. Try to include:

• eat three meals daily
• include foods that are high in fibre - for example wholegrain breads and cereals, vegetables and fruits
• eat a wide variety of foods, for daily vitamin and mineral requirements
• avoid foods containing large amounts of fats - especially takeaways and fried foods
• avoid foods such as cakes, biscuits and soft drinks
• drink plenty of fluids such as water, tea and coffee, and avoid alcohol - which is full of calories
• weigh yourself regularly, and if you keep putting on weight, ask for help from a registered dietitian.

How do I protect my 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
• you are able to take a low dose of calcium tablets. Your doctor will decide this. It can be harmful, particularly in people with kidney disease. If calcium treatment is given, regular blood tests will be done to look for side effects from the calcium
• there are now some other medications that can keep the bones stronger; your doctor can discuss this with you or refer you to a specialist in the bone field. A special sort of x-ray may be needed to measure the density of the bone (it is quite easy and doesn't hurt) before deciding on the best treatment to use, and even whether treatment is needed at all.

When might I need extra steroid doses?

Because the body's own natural steroid production is switched off when you take steroid tablets for a long time, it may not be able to respond quickly enough if suddenly your body needs an extra boost of steroid. So you will need to take extra doses of the steroid tablet instead.

This can happen during illnesses such as bad "flu", operations, asthma attacks and dental work or during any important health problem. See your doctor straightaway if you become ill. Your doctor may be able to help you plan ahead for certain problems.

If you are vomiting or unable to swallow tablets, contact your doctor urgently. You must not be without steroid medicine, particularly if you are unwell.

Stopping long-term steroid treatment

It can be quite dangerous to stop long-term steriod treatment suddenly - the body can find itself seriously short of steroid.

Anyone taking regular steroid tablets should wear a Medic-Alert bracelet. If an accident occurs, and extra steroid is needed, the doctors will know.

When long-term treatment is to be stopped, this must be done very gradually. The dose must be slowly reduced, often over several months. This allows the body time to start making its own cortisone again. Slow reduction will also stop unpleasant side effects, such as severe muscle aches, arthritis and depression.

Slow reduction of steroid treatment must be done by your doctor, and the asthma carefully watched so it doesn't worsen.

Points to remember

• long-term treatment with steroid tablets is only needed in a small number of people with asthma
• good asthma care will reduce the need for steroid tablets
• if you need steroid tablets, your doctor must supervise this treatment. You should see him or her regularly
• side effects can be reduced by taking steroid tablets as a single dose in the morning or every other morning (if this is possible)
• a Medic-Alert bracelet for steroids is only needed by people taking steroid tablets for months or years
• it is dangerous to stop steroid tablets suddenly, if they have been taken continuously for months or years.

Original material provided by the Asthma and Respiratory Foundation of New Zealand. Edited by everybody.