Talk To Your Doctor About Side Effects Of Corticosteroids
Response from Lorene Alba, AE-C
Using a steroid inhaler for asthma can suppress your immune system, so its important to talk to your health care provider to discuss the risks, benefits, and potential side effects of taking these medications. If you need a steroid to manage your asthma, its best to take a daily inhaled corticosteroid when inhaled the medication goes directly into your lungs.
If you take an oral steroid, the medicine is ingested and goes into the bloodstream, which can cause side effects such as weight gain and mood swings. Eating well, getting plenty of sleep, and managing stress will all help keep your immune system working well and reduce the chance of catching an infection like pneumonia.
Editors Note: The information in this article cannot be substituted for medical advice. Always consult your doctor before beginning, ending, or changing treatments.
Eat Slow Wait 20 Minutes
Your brain takes some time to process the fact that youve had enough to eat. Eating quickly means you dont realize youre full until well after youve hit that point, typically resulting in overeating.
Try slowing down. Eat a reasonable serving of food. Then, wait at least 20 minutes and drink a glass of water. Often, youll find yourself feeling full once that break is up.
Healthmore Evidence Animals Protect Some From Asthma
They studied 192 kids aged 5 to 11 who had been treated with controller medications called glucocorticoids at least once in the past year for an asthma flareup. They used Flovent, a common daily inhaler medicine.
They were all doing low-dose maintenance treatment with glucocorticoids: two small doses of Flovent 44 micrograms per snort, twice a day.
As soon as they entered the yellow zone, they either stayed on their regular dose, or took five times that dose.
The quintuple doses of Flovent did not reduce symptoms, Jacksons team reported. And there was a troubling side-effect.
The growth rate among children who had been randomly assigned to the high-dose group was 0.23 cm per year less than the rate among children who had been randomly assigned to the low-dose group, they wrote.
That is a small difference but enough to cause concern. Its already known that glucocorticoids can weaken bone and increase susceptibility to infections.
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Just The Tip Of The Corticosteroid Iceberg:
These are just a few of the messages that have been posted to our website. At last count there were over 800 comments in the feedback section of this post. Feel free to add your story or comment below.
We find it astonishing that some prescribers do not warn patients about the possibility of psychological side effects brought on by prednisone and friends. Even a short-course of high-dose steroid can precipitate symptoms. And not telling patients about gradual tapering borders on bad medicine. To protect yourself and your loved ones from such medical mistakes we suggest our latest book, Top Screw-ups Doctors Make and How to Avoid Them.
Psychological reactions such as insomnia and irritability are common, but they are certainly not the only prednisone side effects. Some of these adverse consequences, such as osteopenia, diabetes or glaucoma, appear only after long-term use of the drug. Others, such as confusion, high blood pressure or a drop in potassium, can occur on a shorter time frame. The most serious prednisone side effects that may happen within a week or two of use are dangerous blood clots , ulcers and infections.
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If You Forget To Give A Dose
If you forget to give a dose, give it as soon as possible. If it is less than 5 hours before the next dose, do not give the missed dose at all. Do not double the next dose.
Instead, go back to your childs regular dosing schedule. If you have any questions about this, check with your childs health care provider or pharmacist.
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Economic Impact Of Scs
While the benefits of short courses of SCS outweigh the risks in patients with acute asthma, we believe these therapies are not warranted in all patients who currently receive them. As well as the health risks of short-course SCS, the economic impact of their use should be noted. Although SCS are inexpensive medications, SCS-related comorbidities/complications pose a high cost to the health system. The direct cost of steroid-induced morbidity in asthma is of major interest and concern .
A recent study in the UK showed a significant association between the extent of corticosteroid exposure and the number of comorbidities in patients with asthma. Furthermore, healthcare costs increased with corticosteroid exposure. In this study, data from the Optimum Patient Care Research Database were analysed for patients who had received at least four short courses of SCS in the previous 2years versus patients with milder asthma or without asthma. Estimated annual cost of corticosteroid-induced morbidity in asthma was nearly six times higher for patients with high- versus low-SCS exposure .
Benefits Of Using Inhaled Steroids
Inhaled steroids reduce inflammation in the lungs, allowing you to breathe better. In some cases, they also reduce the production of mucus.
It can take a few weeks to see results from inhaled steroids. They cant be used to treat asthma attacks right when they happen, but they can prevent future attacks. In many cases, the longer you use the steroids, the less you will have to rely on a rescue inhaler.
Inhaled steroids are corticosteroids. Theyre similar to cortisol, which is a hormone thats produced naturally in the body. Every morning, the adrenal glands release cortisol into the bloodstream, which gives you energy.
Inhaled steroids work the same as cortisol. Your body cant tell whether the cortisol is coming from your body or from an inhaler, so the benefits are the same.
While inhaled steroids are fairly easy to use, a healthcare professional can make sure youre following the proper technique.
The best practices below will help you avoid oral thrush and keep your asthma symptoms from returning:
- Use your inhaled steroids every day, even if youre not experiencing asthma symptoms.
- Use a spacer device with a metered dose, if instructed to do so by your doctor.
- Rinse your mouth with water immediately after using the inhaler.
- See your doctor if you develop oral thrush.
If you no longer need the same level of steroids, your doctor can adjust your dose. Lowering the dose or going off the steroids should be done slowly.
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Stopping Steroid Tablets Safely
Most people on a short course of steroids can safely stop at the end of their course. However, anyone taking long term steroids will be told to reduce the dose gradually. This is because after taking steroids for a long time, your body may not produce enough natural corticosteroids, which can lead to a condition known as adrenal suppression, also known as adrenal insufficiency.
Adrenal suppression can cause symptoms like weight loss and fatigue. It is a rare, but serious complication of being on long term steroids.
If youve been on steroid medicine for a long time, and youre stopping steroid treatment, your doctor may monitor you and will consider blood tests to check your cortisol levels. Sometimes your doctor may prescribe hydrocortisone tablets to support your body as you stop taking steroids and your corticosteroid levels drop. Hydrocortisone tablets contain a different type of steroid to the glucocorticoid steroids in prednisolone. They are sometimes used to replace a specific type of steroid produced naturally in the body. The body can stop producing this when someone is on corticosteroids for a long time. In many cases, adrenal suppression corrects itself in time.
In some cases stopping steroid medicines suddenly causes adrenal crisis. This is where levels of cortisol in your body drop dramatically. Its a life-threatening emergency.
Always carry a steroid card
What Can I Do To Make It Easier To Breathe When Its Humid Outside
When its hot and humid outside, there are some things you can do to try and lessen the effects on your asthma.Lessen other asthma irritants by avoiding things that you know will trigger your asthma. For example, perfumes, aerosols, and smoking.
Here are some tips on how to cope with both humidity and asthma during the warmer months:
- Stay on top of your preventive medicines and talk to your doctor right away if they dont seem to be effective.
- Install a dehumidifier in your home or purchase a portable one. Set it to keep your home between 30 and 50 percent.
- Stay indoors/keep on your air conditioner as much as possible. This keeps the air moving in your home and help prevents the mold from growing and dust mites from breeding.
- Avoid strenuous exercise outdoors during the hottest and most humid times.
Having asthma can make catching your breath a bit tougher in the summertime, but if you are armed with a little knowledge and some common sense, you can muddle through just fine.
Are there any tips we missed? Be sure to share them with us if so.
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What Are Inhaled Steroids
Inhaled steroids, also called corticosteroids, reduce inflammation in the lungs. Theyre used to treat asthma and other respiratory conditions like chronic obstructive pulmonary disease .
These steroids are hormones that are produced naturally in the body. Theyre not the same as anabolic steroids, which some people use to build muscle.
To use the steroids, first put the inhaler up to your mouth. Breathe in slowly while pressing on the canister attached to your inhaler. This will direct the medicine right into your lungs. Your doctor will advise you to use the inhaler every day.
Inhaled steroids are often used for long-term treatment. They help prevent future asthma attacks by keeping the lungs healthy and relaxed. Inhaled steroids are also sometimes used along with oral steroids.
The most common inhaled steroids are listed below:
Generally, inhaled steroids have very few side effects because the medicine goes directly into the lungs.
Severe Asthma Treatment Options
One bright light has been the development of biologics, a class of drugs made from living organisms. These medications can target specific points in the bodys inflammatory response, lessening severe asthma symptoms. They include:
Anti-interleukin-5 injections: Reslizumab and mepolizumab can be used to treat severe asthma caused by an excess of eosinophils, a type of white blood cell that leads to inflammation. These medicines reduce eosinophils and help prevent asthma exacerbations.
Immunoglobulin E inhibitors: When an allergic reaction causes severe asthma symptoms, omalizumab can help. This injection blocks IgE, an antibody thats produced when youre exposed to allergens like pet dander and dust mites, reducing your risk of having an asthma attack.
Bronchial thermoplasty is a different type of treatment for severe asthma. Completed as a series of short outpatient procedures, it uses heat to decrease the amount of muscle in the airway, making it harder for the airway to contract. Patients undergoing bronchial thermoplasty report a decrease in the number of asthma attacks and a much lower incidence of emergency room visits.
If youre struggling with frequent asthma flares, even when youre taking your medications correctly and avoiding known triggers, talk to your doctor. Many things need to be ruled out first, but if youre diagnosed with severe asthma, be sure to explore all of your treatment options.
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Proper Inhaler Technique Can Minimize Side Effects
Side effects of using a steroid inhaler can be prevented by using proper technique and precautions. When breathed in, some steroid medicine remains in the mouth and can be swallowed into the stomach and from there absorbed into the bloodstream. You can minimize any effect from steroids left behind in your mouth in two ways.
First, use a spacer tube with your steroid spray . Medicine that would otherwise land on your tongue and mouth stays in the spacer chamber. The part of the spray that passes through the spacer also tends to pass through your mouth and proceed down onto the bronchial tubes. Second, gargle and rinse your mouth with water after inhaling the steroid spray. Rinsing removes any medicine residue from your mouth. The portion of the medicine that helps your asthma remains undisturbed on your bronchial tubes.
Added Value: Should Our Food Be Fortified With Vitamins And Minerals
This week: White flour
Since World War II, white flour in the UK has had to be fortified with calcium, iron, niacin and thiamine .
White flour has been fortified in the UK with vitamins
The idea was to boost flour’s nutritional value at a time when many people were on short rations.
The government recently decided to keep this fortification mandatory. ‘It saw that there were still benefits to be had, particularly among vulnerable groups such as older people,’ says dietitian Ursula Arens.
The limits are set so that it would be difficult to overdose by eating baked goods.
THE DOWNSIDE: ‘Cumulatively, you could exceed recommended amounts, particularly if you take high-dose supplements, too,’ says dietitian Frankie Phillips. So those taking supplements of more than 20mg a day of iron, for example, who also eat lots of white flour-based products may experience nausea and vomiting.
Professor Barnes is concerned that undiagnosed patients are missing out on interventions that, if started early enough, can help manage the condition. Also, an asthma misdiagnosis may lead to the wrong treatment, raising the risk of life-threatening infections.
The condition is resistant to steroids because the inflammation is caused by different types of cells, explains Professor Barnes.
In asthma, it is mainly due to eosinophils, white blood cells produced by the immune system as part of an allergic response.
Others who received a late diagnosis are housebound and rely on portable oxygen cylinders.
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What Are The Implications
This study strengthens the evidence for asthma self-management and the strategy of quadrupling the dose of inhaled corticosteroid to reduce exacerbations.
Although it follows recommendations in the existing NICE guideline, previous evidence had not been strong. This studys findings increase confidence in the research underlying current recommendations and give a quantitative estimate of the benefit.
The trial was designed to follow usual care as much as possible, so the findings should generally apply to asthma care in the UK.
Are Prednisone And Other Oral Steroids Safe For Asthma
While a two-week course or “short burst” of oral steroids like prednisone is relatively safe, itâs important to avoid steroids on a long-term basis as there are potential serious side effects. Taking supplemental calcium may help to prevent osteoporosis or thinning of the bones, which is one of the side effects of long-term steroid use.
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What Is The Difference Between Prednisone And Prednisolone
Both prednisone and prednisolone are man-made glucocorticoids. They are used to treat similar conditions and are generally considered equally effective. However, in people with liver disease, prednisolone is usually preferred. This is because prednisone needs to be converted by liver enzymes into prednisolone before it can work.
Price wise, prednisone is usually much cheaper than prednisolone.
Treatments That Can Affect Sleep
The following treatments have the potential to affect sleep.
You may be taking steroids as part of your cancer treatment. Steroids cause sleep disturbance. It can help if you take them in the morning.
Anti sickness drugs
Some anti sickness drugs can make you feel restless. If this happens, tell your doctor as you might be able to have a different type.
Some cancer treatments such as targeted cancer drugs can cause insomnia. Ask your pharmacist or doctor if the drug you are taking can affect your sleep.
If cancer or its treatment has affected your hormone levels, or you are taking certain hormone drugs, then you may experience hot flushes and sweats. These can interfere with your sleep. Talk with your doctor if hot flushes are a problem for you.
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Which Medicines Make Asthma Worse
When talking about asthma triggers with other people, no one would mention that certain medicines can be asthma symptoms triggers. And who in the world would think that medications cause asthma symptoms, when medications make people healthy, not ill? However, in reality, there are some medications that may trigger and worsen asthma symptoms. Before you commence with medication other than youre your asthma meds, you should inform your doctor about it.
Increasing Inhaled Steroids For Short Periods Reduces Asthma Exacerbations
This is a plain English summary of an original research article
Taking four times the usual dose of inhaled corticosteroids for up to two weeks can modestly reduce the chance of asthma worsening.
This NIHR-funded trial assessed increasing the inhaled corticosteroid dose compared with staying on the usual dose, as part of a self-management plan. Participants were adults and adolescents with uncontrolled asthma and had at least one exacerbation needing additional medical attention in the year before the trial.
Quadrupling the inhaled corticosteroid dose when asthma worsens is already recommended by NICE guidance, but previously there was little research evidence to support the clinical practice. What there was, suggested that doubling the dose of inhaled corticosteroids was not effective and quadrupling the dose had been tested in trials with very few people. The results of this trial increase the confidence in this as a valid approach.
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Can Steroids Cause Shortness Of Breath Or Make Asthma Worse
In some cases, yes. Steroids are the go-to treatment for asthma management and are well tolerated by most people. However, there is a subset of patients whose asthma fails to improve or who experience worsening symptoms.
One reason for this is an allergy to aspirin. If you have a history of allergic reactions to aspirin, you can develop corticosteroid-induced bronchospasm.¹ This essentially means that you are allergic to the steroid medication. This occasionally also happens without a history of aspirin allergy.
However, such a reaction is very rare the incidence of adverse reactions to systemic treatment is 0.3%. Typically this means you will be given a preventer inhaler with one of the alternative medications. While these are not as effective, they are likely safer for you.
Another subset of patients that may not respond to steroid treatment for asthma are people with elevated levels of CXCL 10. This is an inflammatory protein, and high levels are associated with more severe asthma. The condition causes resistance to corticosteroid therapy and is experienced by 5%10% of patients with severe asthma.
It is much rarer in people with mild to moderate asthma, likely because high CXCL 10 levels make asthma worse.
Both of these circumstances are relatively rare, but it is important to go straight to your doctor if your symptoms do not improve or worsen after taking corticosteroids, whether inhaled or oral.