Steroids

Find out why steroids are used to treat lung conditions like asthma and chronic obstructive pulmonary disease (COPD). 

What are 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. You may need extra corticosteroids for your lung condition, to help keep down the inflammation in your airways. These are prescribed in an inhaler or as steroid tablets.

If you have asthma, you’ll be prescribed steroid preventer medicine, usually in your preventer inhaler. You need to take this every day to keep down the inflammation in your airways.

Reliever inhalers

You may have been prescribed two inhalers. A preventer and a reliever (usually blue).

The reliever inhaler does not contain steroids. Relievers are used to open your airways when you’re having symptoms or an asthma attack.  

If you’ve been prescribed a MART inhaler (Maintenance and Reliever Therapy) you will be prescribed one inhaler to work as a preventer and a reliever. It opens up the airways and also gives a dose of preventer medicine to deal with inflammation.

Steroid inhalers

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 your symptoms.  

The steroids in your preventer inhaler prevent inflammation from building up in your airways.

Taking your steroid preventer inhaler every day as prescribed means your airways will be less inflamed, and you’ll be less likely to have a flare-up of your condition, react to your asthma triggers and have symptoms or an asthma attack.

It’s important to take your steroid preventer inhaler every day, even if you feel well. Find out more about preventer inhalers.

Steroids and their side effects

Hi, I’m Andy, Asthma + Lung UK’s GP. Steroids work by calming down the inflammation in the lungs. They’re mainly used for asthma, but can sometimes be helpful for people with COPD, particularly those who have asthma as well. Steroids can sometimes be used to treat other medical and lung conditions too.

The steroids used to treat asthma, COPD, and other lung conditions are not the same as the anabolic steroids which are used by some athletes. As a GP, I often see people worried about taking steroids for their lung condition. Firstly, I reassure them that we always prescribe the lowest dose needed for their condition. Most steroid inhalers have low doses of steroid medicine in them anyway.

Secondly, side effects are more likely if steroids are taken long-term or at high doses. Before prescribing steroids, doctors always consider the risks and the benefits. Even though steroids have some side effects, they can also be a life-saving treatment. Taking a steroid preventer inhaler for asthma means you’re less likely to react to your asthma triggers like pollen, pollution, stress, and exercise.

Reducing the inflammation and swelling in your airways using steroids means you’re less likely to get asthma attacks. Steroids are also useful for people with COPD who get regular flare-ups. For COPD, steroid inhalers are most useful for people whose condition has asthma-like features, like a history of allergies, or when you have both COPD and asthma together.

Your doctor may prescribe steroid inhalers for COPD if your symptoms get worse, or if you’ve been having a lot of flare-ups. Sometimes you may need a short course of steroid tablets if you have poorly controlled asthma, an asthma attack or a COPD flare-up. Steroids are really important in these cases to treat the inflammation in your lungs, and get you well again.

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. Sometimes you may need a longer course of steroids. This is usually only for people with asthma that’s difficult to control, or severe. If this is the case, you should be
under the care of a specialist. Long-term oral steroids are not usually recommended for COPD. It’s understandable that people worry about side effects of using steroids.

If you’re using a steroid inhaler these medicines act directly on the airways, and generally have very few side effects. Any problems like a sore mouth, for example, can be prevented by using a spacer with your inhaler, if that’s possible. And always rinse your mouth with water and spit it out after using your inhaler. Good inhaler technique is also important.

You may notice more side effects if you need to take high doses of your inhaler for a long time. If you have COPD, high doses in your inhaler over a long-term can mean an increased risk of pneumonia. Long-term steroid tablets can have side effects, like weight gain, bone thinning, bruising of the skin, and possibly diabetes. If you have had several
courses of steroid tablets or have been put on them for a longer period of time, speak with your doctor or healthcare professional about what you can do to reduce the chance of getting these side effects. Always get your medicines reviewed regularly so your doctor can make sure you’re on the right dose for you.

Also, talk to them about whether you need to carry a steroid card. This lets healthcare professionals know you’re taking steroids. It’s really important that you don’t stop taking your steroids in an inhaler or tablets suddenly if you’ve been taking them for more than a few weeks. Steroids in an inhaler or as tablets are an important and effective treatment for inflammation in the lungs and can make a massive difference to how you deal with your condition.

If you have any concerns about the medicines you take for your asthma, COPD, or other lung condition, speak to your doctor, nurse, pharmacist or other healthcare professional and you can also call our helpline.

Steroid inhaler side effects

Your steroid preventer 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:

Your doctor or asthma nurse will always aim to prescribe the lowest steroid dose in your preventer 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.

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.

Steroid tablets short-term

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.

Steroid tablets long-term

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 the maximum doses of a preventer 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.

Always carry a steroid card

Remember to always carry your steroid card. A steroid card lets healthcare professionals know you take steroid medicines and provides life-saving information in the event of an emergency.

Steroid tablet side effects

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:

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.

Steroid cards

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 preventer 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 asthma nurse what your total daily dose of steroid medicine is, from your preventer medicine 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.

Get support

Call or WhatsApp our Helpline for support with your condition. Get advice on your medicines, symptoms or travelling with a lung condition, or just call us to say hello.

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