What are steroids?
How are steroids given?
Inhaled steroids
Inhaled steroids in asthma
Steroid tablets in asthma, short-term
Steroid tablets in asthma, long-term
What other chest conditions are treated with steroids?
Side effects of steroid tablets
Many types of steroids are made naturally in our bodies. They are made by two small glands, called adrenal glands, which sit above the kidneys.
Steroids produced by the adrenal glands are also made artificially. One of these steroids, corticosteroid, is used in medicines to treat many medical conditions, including some lung diseases.
Corticosteroids are nothing to do with anabolic steroids, used illegally by some athletes and bodybuilders. They are also different to female hormones, such as those used in the contraceptive pill and hormone replacement therapy.
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1. Topically. This means that the medication is given directly to where the illness is. For example: nose drops for hay fever; creams for skin diseases; inhalers for asthma.
Since the medication only goes to where your illness is, the dose is small. Very little gets into the blood stream, so there are very few side-effects.
However, topical drugs can only travel a very short distance into the disease area, so they don't work as well when the inflammation is severe.
2. Systemically. This means that the medication travels to the site of the disease. It is normally given by tablet and absorbed into the bloodstream. Sometimes the medication is given by injection.
Systemic drugs are used when topical medication can't treat the disease fully. The commonest steroid tablet is prednisolone.
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Inhaled steroids are the main treatment for asthma. They can also be used to treat COPD and, occasionally, other lung diseases.
Inhaled steroids benefit asthma and COPD because they are mainly diseases of the airways (the tubes that carry air in and out of the lungs).
Occasionally, when these conditions are severe, steroid tablets are also needed.
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Since asthma is usually a long-term condition which makes your airways sensitive and inflamed, you often need daily long-term inhaled steroids.
These steroids help your cough disappear and help to keep your airways open. This means you need less relief (rescue) inhaler. If treatment is stopped, inflammation of the airways will come back.
Because the dose of steroids is low, side-effects are unusual. Sometimes you can get thrush in your mouth, but that is usually because inhaled medicine sticks to the back of your throat. You can avoid this by adding a spacer or switching to a dry-powder inhaler. Speak to your GP or respiratory nurse about which is best for you.
Another uncommon problem is that your voice can become weak. This happens because some of the inhaled steroid lands on your vocal cords and weakens the muscles (all inhaled treatment has to go through the voice box to reach your airways).
Common inhaled steroids include beclomethasone, budesonide and fluticasone. These steroids vary mainly in strength and how you take them.
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Short-term steroid tablets can help your doctor or nurse check if you really have asthma. They can also treat people with asthma or COPD whose condition flares up. They are not usually given for more than two weeks.
Many people are offered a spare supply of these tablets that they can take at the first sign of a flare-up. This is useful if you can't get an appointment with your doctor straight away, or if you are going on holiday. It's also useful if you've been admitted to hospital because of asthma. By taking the tablets at the first sign of a flare-up, you can prevent readmission.
Although steroid tablets make you feel hungrier, short courses do not normally cause any of the long-term side-effects listed over the page.
They occasionally cause temporary indigestion or some change in bowel habits. If you become ill while you are on steroid tablets, or if you come into contact with anyone with an infectious disease - avoid people with chicken pox or shingles - then you should visit your GP straight away. People with diabetes need to keep a careful eye on their blood sugar level.
For a short course, treatment can safely be stopped immediately. A 'steroid card' - which records how much prednisolone you are on and how often you take it - is not necessary.
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There are a few people who cannot fully control asthma with a combination of inhalers and non-steroid tablets. They might even get worse shortly after coming off a course of prednisolone (the commonest steroid tablet), with the risk of lung damage gradually getting worse.
As a result some people have to combine daily prednisolone and inhaled steroids. This combination is not ideal, but it may prove the best way of treating your condition. In fact, it can give an overall lower dose of steroids than having to take frequent courses.
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- Sarcoidosis - since this involves the lung tissue rather than the airways, steroid treatment is taken by tablet. Inhaled steroids may be prescribed, but this is rare.
- Tuberculosis (TB) - in very bad cases of TB steroid tablets may be given with TB medicines.
- Lung cancer - in people with advanced lung cancer, appetite, weight and general well-being are often improved by steroid tablets.
- Other - systemic steroids are also used in: (a) lung transplantation to prevent rejection (b) treatment of lung prematurity in infants (c) eosinophilic pneumonia and (d) cryptogenic organising pneumonia (COP/BOOP). Initial treatment may be intravenous (injected into a vein), with either hydrocortisone or methylprednisolone.
For information about steroid treatment for COPD please go here.
In chest conditions (other than asthma) that need steroids, you may be started on a high dose. This is later reduced to the lowest dose possible to keep your condition under control.
Once this has been achieved you may be prescribed double the dose, but only every other day. This reduces the risk of side-effects while maintaining the overall benefit of the medicine.
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With long-term use of steroids, side effects can become a real problem. These include weight gain, puffy face, thin skin with easy bruising and thinning of the bones (osteoporosis); in children another problem can be slowing of normal growth. Steroids can also affect control of diabetes. Tablets can disturb sleep so you should only take them in the morning.
If you take steroid tablets on a long-term basis you need regular checks to see whether:
- your diagnosis is right
- the disease has become less active or inactive
- the dose can be reduced by adding in other medication
- you should receive a regular test for osteoporosis.
Finally, if you are taking steroid tablets long-term, remember that:
- you should not stop taking them suddenly
- you should carry a ‘steroid card’ around with you at all times
- if you have an infection or operation you need a higher dose of steroids. Your doctor or nurse will give you the advice you need.
Page last medically reviewed: January 2008
