Asthma Drug Treatment - Side Effects from Steroid Preventers

Inhaled steroids are a very efficient treatment for asthma, and for many people they can represent the difference between being ill and living a normal life. Doctors confidently prescribe them because they are convinced that the benefits vastly outweigh the risks.

However, many people have a knee-jerk reaction to steroids on the lines of "steroids -me? You must be joking."

This extreme response may lead doctors to err on the cautious side, and play down the side effects of steroids rather than take the risk that patients will refuse to take them.

Research shows that failure to take these prescribed steroids is extremely common. Patients with asthma seldom confront their doctors about their side-effect worries, and they simply tend to leave the steroid inhaler unused in its box.

Inhaled preparations give a much lower dose of steroid than tablets because the drug goes straight to the airways rather than being broken down in the body. Nevertheless, a little of the inhaled steroid is inevitably swallowed and thereby absorbed into the bloodstream. However, there is no medical evidence that low-dose inhaled steroids cause any major side effects.

People who take inhaled steroids have an increased risk of getting thrush infections of the throat and mouth, hoarseness, and coughing. Rinsing the mouth after taking the drug, using one of the spacers described below and eating live yoghurt all help to reduce these unwanted side effects.

Sometimes the standard dose in steroid inhalers is not enough and higher strengths of the drug are required.

Spacer devices help to reduce the risks of steroids being absorbed into the body. They do this by making it easier to inhale the drug. This, in turn, reduces the amount of steroid which is deposited in the back of the throat and then swallowed and absorbed by the body.

Nevertheless, an increased dose does carry an increased risk of side effects. This risk is, however, less than with the alternative steroid tablets, and is certainly less risky than experiencing a severe and uncontrolled asthma attack.

A short course of steroid tablets may cause a slight weight gain and even mood changes, especially in children. However, the risks of two or three short courses in a single year are considered to be low.

Longer courses of steroids, taken over many months, can cause some weight gain, the thinning of the bones (osteoporosis), increased blood pressure, stomach ulcers and an increased risk that diabetes will occur in people who are already predisposed to develop it. The magnitude of the risk from steroids depends on the dose. Side effects become more likely on doses which exceed 5mg a day.

Steroid tablets are usually taken in the prescribed dose once a day only, rather than several times a day, to reduce the side effects. Sometimes they are taken on alternate days.

Patients who need high-dose tablets may feel that they are between a rock and a hard place. If asthma is very severe, and making normal life impossible, or indeed if it is life-threatening, they may decide they have no choice but to take the drugs.