Steroids

The steroids used to treat asthma and some other lung conditions are known as corticosteroids. These are not the same as the steroids that some athletes use which are called anabolic steroids.

The body naturally produces corticosteroids to help reduce injury or inflammation. 

When you have asthma, and sometimes when you have COPD (Chronic Obstructive Pulmonary Disease), you need a medicine containing corticosteroids to help keep down certain types of inflammation in your airways. Corticosteroids are prescribed in an inhaler or as steroid tablets.

Steroid inhalers are usually prescribed to people with asthma. They’re also prescribed to some people with COPD who get regular flare-ups, particularly when COPD has asthma-like features, or if they have asthma alongside their COPD. They help by preventing symptoms.  

You might be prescribed a preventer inhaler or a combination inhaler containing steroids. The steroids in your inhaler prevent certain types of inflammation from building up in your airways. 

Take your steroid inhaler every day as prescribed, even when you feel well. It means your airways will be less inflamed, so you're less likely to have a flare-up of your COPD, asthma symptoms, or an asthma attack.

Find out more about preventer inhalers or combination inhalers.

Your steroid inhaler is unlikely to cause side effects, especially if you’re using your inhaler correctly.

However, some people get side effects like a sore throat, a hoarse voice, or oral thrush.

You can lower your risk of side effects by:

• using your inhaler with a spacer  
• gargling and rinsing your mouth out 
• getting your inhaler technique right.

Your doctor or nurse will always aim to prescribe the lowest steroid dose in you steroid inhaler – enough for you to get good control over your symptoms, but as low as possible to reduce your risk of side effects.  

But if you’re taking high doses for a long time, you may be at risk of some of the same side effects as steroid tablets.

You’re most likely to be prescribed oral steroids if you have a flare-up of your symptoms or an asthma attack. This should be a short course to deal with symptoms, and once you’ve finished the course, your doctor will advise you how to safely stop taking them.

You may need a one-off, short course to help you treat a flare-up or an asthma attack. This is important for your recovery, and unlikely to cause harmful side effects.  

If you have asthma and need two or more short courses in a year, or your symptoms keep coming back once you’ve finished the course, you should ask your GP for a referral to a specialist clinic. This is because it’s a sign your asthma is difficult to control.

Some people with COPD are given a short course of steroid tablets to keep at home, as part of their flare-up rescue pack, but you must have clear instructions about when and how to use them.

You may need a longer course, or to take steroid tablets continuously if your symptoms are not well controlled despite other treatments, or while you are waiting for alternative treatments, such as biologic treatments for asthma.

Some people may need to continue taking them if they are not eligible for biologic treatments. If you’re taking steroid tablets continuously you should be under the care of a respiratory specialist.

You’re more likely to be prescribed steroid tablets long-term if:

• your asthma is not controlled with a regular high dose steroid preventer or combination inhaler and other add-on treatments 
• you have advanced COPD 
• you’re waiting to be considered for other severe asthma treatments, like biologics 
• your symptoms get worse again each time you come off a short course of steroid tablets.

Long-term oral steroids are not usually recommended for COPD.

You’re less likely to get side effects from taking steroid tablets for less than three weeks.

Side effects are more likely if you take steroid tablets for three weeks or more or you need four or more short courses a year.

These side effects include:

• upset stomach
• heartburn
• wanting to eat more and putting on weight
• a ‘moon-shaped’ face (Cushing’s syndrome) 
• finding it hard to sleep
• feeling anxious or having mood swings.

These kinds of side effects usually stop once the course of tablets has finished. But if you need to keep taking steroids you may be at risk of more long-term problems, including:

• steroid-induced diabetes
• thinning of the bones or osteoporosis
• glaucoma.

If you have COPD, high doses in your inhaler over the long term can mean an increased risk of pneumonia.

If you’re worried about any side effects, ask your healthcare professional for advice as soon as you can. For example, if you have an upset stomach after taking steroids, your GP may suggest taking the tablet with meals or after food.

Some people who take medicines containing steroids may need a steroid card in case of emergencies. It depends on what total daily dose of steroid medicine you’re taking and for how long.

For example, your doctor may ask you to carry a steroid card:

• if you need oral steroids (for example prednisolone) for longer than four weeks 
• if you’ve needed several short courses of oral steroids in a year 
• if your inhaler contains high doses of steroid medicine
• you’re taking other types of steroid medicine, for example, steroid nasal drops or steroid creams, alongside your steroid inhaler, which could add up to a high overall dose.

You can get a steroid card from your GP. A steroid emergency card lets healthcare professionals and emergency doctors know you take steroids.  It is useful in emergency situations, for example, if you’re in an accident or become seriously ill.

This is because when you’re on high doses of steroids your body may stop producing enough of its own natural steroids to help illness or injury. So, doctors will need to give you extra corticosteroids.

At your next appointment, ask your doctor or nurse what your total daily dose of steroid medicine is, from your steroid inhaler and any other steroid medicines you’re taking. Check with them if you should be carrying a steroid card.

If you need a steroid card, make sure you always carry it with you. If you lose it, you can get a replacement from your pharmacy or GP.