Lungnet

What are corticosteroids?

The corticosteroid drugs used medically are similar to those occurring naturally in the body and produced by the adrenal glands. These natural hormones are essential to the body in fighting stress, injury and disease. They are not the same as the steroids used by athletes to improve muscle bulk and performance.

Corticosteroids (sometimes called "cortisone") are effective anti-inflammatory drugs often used to help control inflammatory diseases, for example, in the bowel (colitis), in the joints (arthritis), in the skin (dermatitis) and in the lungs.

Asthma is caused by inflammation of the air tubes, and is the main lung condition where corticosteroids are used but sometimes they can also be helpful when lungs are damaged by cigarette smoke as in chronic bronchitis and emphysema. Corticosteroids are useful in the treatment of other lung diseases such as sarcoidosis, and chronic inflammatory conditions such as alveolitis (inflammation of the lung tissue itself).

How are corticosteroids administered?

These drugs may be given by mouth (tablets), by injection or by the inhaled route using an inhaler or dry powder device. Inhaled corticosteroids such as Flixotide^TM, Pulmicort^TM, Qvar^TM, Respocort^TM, Seretide^TM, and Symbicort^TM, are preferred for asthma because they act locally on the airways and have fewer side-effects. Inhaled medication must reach the small air passages in the lungs to be effective and this requires the correct use of the inhaler. Your doctor will advise you on the correct method for use.

How do corticosteroids work?

The most important action of corticosteroid drugs is to reduce inflammation. Inflammation of the inner lining of the bronchial tubes in the lung is the major cause of asthma symptoms. The anti-inflammatory action of corticosteroids makes them the most effective anti-asthma treatment.

When should I take inhaled corticosteroids?

For asthma, a corticosteroid should be used by inhalation wherever possible. Corticosteroids by mouth or by injection are only advised in acute attacks of asthma or where the control of your asthma is deteriorating. Oral or injectable corticosteroids are sometimes used in other respiratory conditions. Corticosteroids used in this way are usually given for a few days to a few weeks only, although in some of the chronic inflammatory conditions of the lung (eg. alveolitis or sarcoidosis) they may be needed for longer periods. Your doctor will advise you on the most effective method in your case.

What are the side effects?

Side-effects of corticosteroids are more common when they are taken for prolonged periods and in very high doses, but may still occur at lower doses and over shorter periods in some patients. It is common in many respiratory diseases, such as asthma, for the doctor to prescribe corticosteroids for only one or two weeks, although occasionally treatment is needed for longer periods and side effects may occur. Inhaled corticosteroids (eg Flixotide^TM, Pulmicort^TM, Qvar^TM, Respocort^TM, Seretide^TM, and Symbicort^TM) are preferred to corticosteroids taken by mouth (eg prednisolone, dexamethasone, cortisone acetate) because the dose required is much less and is delivered directly to the lungs. In addition, there are fewer side effects associated with inhaled steroid use. The commonest of these are hoarseness of the voice and a sore throat. The sore throat may be due to the development of a fungal infection (thrush) or due to the propellant in the puffers. Mouth washing and gargling after each dose and the use of a spacer device, such as a Volumatic^TM and Nebuhaler^TM will help avoid these problems.

Oral corticosteroids have a bad reputation in the community largely because of the side-effects which are more common, particularly weight gain, increased susceptibility to infection, slow healing, easy bruising, growth retardation in children and thinning of the bones (osteoporosis), particularly in women during and following the menopause. In some people, corticosteroids may also worsen an underlying diabetic tendency and make diabetes more difficult to control. Sometimes emotional upset such as depression can be troublesome. Corticosteroids may impair the healing of the lining of the stomach leading to bleeding from previous ulcers. You should notify your doctor if you have ever suffered from peptic ulcers, indigestion or heart burn. A rare but serious side effect is damage to the hip joints when taken in high dose for prolonged periods.

When corticosteroids are taken in doses which suppress the body's own production from the adrenal glands, it is important that they are not stopped suddenly and/or without consulting a doctor as it may take weeks or month for the patients' own adrenals to recommence corticosteroid production. This can lead to a period when blood corticosteroid levels may fall too low with serious health consequences.

In most clinical situations, the benefits of corticosteroids far outweigh the disadvantages and with due care and planning, many of the above side effects can be anticipated or reduced. Should you have any worries regarding possible side effects, report them to your doctor sooner rather than later.

Please Note: This information is intended by The Australian Lung Foundation to be used as a guide only and is not an authoritative statement. Please consult your family doctor or specialist respiratory physician if you have further questions relating to the information provided here.

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Content updated August 2005