Asthma and Steroids in Tablet Form
They serve as hormones —chemical signals that help to regulate the body's growth and function. Some steroid hormones, like testosterone, stimulate formation of protein and growth of muscle. Competitive athletes have been known to take illicitly derivatives of these "body-building" steroids in large amounts to improve their athletic performance. A very different group of steroid hormones are the corticosteroids, steroid hormones made in the cortex hence, "cortico-" of the adrenal glands, which sit adjacent to the kidneys.
Corticosteroid hormones have many different affects on body function, including influences on how we use our energy stores fat, protein, and sugar and how we adjust the salt and water content of our body. Early in this century it was discovered that corticosteroid hormones, if purified and taken in large amounts as a medicine, have powerful anti-inflammatory effects.
Ever since this discovery, corticosteroids have been used to treat a great variety of diseases where inflammation not infection and not cancer is the major problem—from arthritis to psoriasis to asthma. When you and your doctor talk about steroids to treat your asthma, it is these anti-inflammatory corticosteroids about which you are speaking. To treat the inflammation of asthma within the bronchial tubes, steroids can be taken in tablet or liquid form or by inhalation.
Occasionally, steroids are given by injection or—in hospitalized persons —directly into the veins intravenous infusion. Taken as tablets, liquid, injection, or intravenous infusion, the steroid medication travels in the blood and is carried throughout the body, including to the bronchial tubes.
Used in this way, steroids have their most powerful effects— both for the good relieving asthmatic symptoms and for the bad undesirable side effects. On the other hand, modern steroid medications inhaled on the bronchial tubes from pressurized canisters act directly on these tubes; almost no medication is carried into the bloodstream. Although not as powerful in their immediate effects, steroids by inhalation are better suited for long-term use in the treatment of inflamed bronchial tubes because they are free of major undesirable side effects.
Examples of steroids in tablet form are prednisone Brand name: Examples of steroids by inhalation are triamcinolone Brand name: More information about the inhaled steroids is available in a separate pamphlet prepared by the Partners Asthma Center, entitled, Asthma and Inhaled Steroids. The remainder of this pamphlet focuses on the use of steroids in tablet or liquid form. Steroids taken in tablet or liquid form "oral steroids" are usually prescribed for asthma that has become difficult to control by any other means; they are the most effective treatment available for a severe "attack" of asthma.
Most often, they are prescribed for a short period of time: They are stopped when the asthma has gotten better and other treatments suffice to keep it under control.
Longer periods of treatment and continuous treatment with oral steroids are generally avoided except for the most difficult-to-control asthma because of the undesirable side effects that often develop with prolonged oral steroid treatment. As a rough guide, we consider less than 20 milligrams abbreviated "mg" of prednisone a low dose, 20 to 30 mg a moderate dose, and 40 to 60 mg a high dose of oral steroids.
When rapid relief from an asthma attack is needed, a high dose will often be recommended initially, followed by a gradual reduction in dose on successive days until the oral steroids are stopped: There is no single schedule of oral steroid dosing that is right for all asthma attacks in all patients.
Most often, we recommend taking the tablets altogether in the morning. Sometimes the steroid dose is divided up during the day and on occasion even given once daily in the evening. The beneficial effects of oral steroids are usually evident within several hours.
Breathing becomes easier and wheezing, cough, mucus production, and chest tightness all gradually lessen. Other allergic diseases, such eczema and nasal congestion and drip, are also likely to be helped by the anti-inflammatory action of the oral steroids. Many people also find that oral steroids, independent of their effect on breathing, give a powerful boost of energy—for a short while.
Undesirable side effects of oral steroids are common, even during a short course. Any individual person may experience none, some, or all of these side effects, which generally go away quickly when the medication is stopped.
These side effects include: Women may have their menstrual cycle become irregular for a brief while and may develop a vaginal yeast infection. Rare complications include loss of a sense of reality psychosis , triggering the onset of diabetes, and injury to the bone in a joint aseptic necrosis of a bone.
When the steroid dose is being tapered or stopped, one may experience a different set of side effects. Bear with them; these side effects will go away in a short while.
If taken for a long time months to years , daily oral steroids, especially in moderate to high doses, can cause many harmful side effects. These complications of long-term use include cataracts of the eyes, thinning of the bones osteoporosis , weakness of the muscles myopathy , fragile skin with a tendency to bruise easily, hair loss, facial hair growth in women, puffy cheeks, a fatty bulge at the base of the back of the neck, and weight gain.
Long-term steroid use also predisposes to certain types of unusual infections, to the development of high blood pressure and diabetes, and to shrinkage of the glands that normally make corticosteroid hormones in the body, the adrenal glands. This latter effect makes it dangerous to stop suddenly oral steroids if you have taken them regularly in moderate to high doses for more than about 3 to 4 weeks. You might then become sick from a lack of the normal amounts of corticosteroids in your bloodstream, a condition called "adrenal insufficiency.
To prevent this from happening, your doctor would routinely provide you with supplemental steroids either by tablet or by intravenous infusion. A severe attack of asthma that is not getting better with other treatments is dangerous. A short course of oral steroids for severe asthma can often keep you from being rushed to the Emergency Department of the hospital for treatment of your asthma, can prevent the need for hospitalization, and—in an extreme case—can save your life. Many asthmatic patients have said that when you need them, oral steroids "work like a miracle.
Their risk comes only with overuse or prolonged continuous use; and long-term oral steroid use is not necessary for the vast majority of persons with asthma because other effective treatment strategies are readily available. Watch the interview of Dr. Steroids Swallowed or Steroids Inhaled To treat the inflammation of asthma within the bronchial tubes, steroids can be taken in tablet or liquid form or by inhalation.
A Short Course of Steroids Steroids taken in tablet or liquid form "oral steroids" are usually prescribed for asthma that has become difficult to control by any other means; they are the most effective treatment available for a severe "attack" of asthma. Effects of a Short Steroid Course The beneficial effects of oral steroids are usually evident within several hours.
Undesirable Side Effecs of a Short Steroid Course Undesirable side effects of oral steroids are common, even during a short course. Undesirable Side Effects of Prolonged Use of Oral Steroids If taken for a long time months to years , daily oral steroids, especially in moderate to high doses, can cause many harmful side effects. Are Steroids too Dangerous? Should They Be Avoided?
Patient Resources Upcoming Events Videos Publications guide to asthma harvard medical school guide to taking control of asthma breath of fresh air newsletter best of breath of fresh air brochures Patient Information Survey Peak Flow Calculator Useful Links.