Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.
To control asthma over the long term, it is imperative to understand how to manage medications to keep symptoms under control and avoid future asthma attacks while also minimizing side effects from these medications. Corticosteroids, commonly known as steroids, are the most effective and commonly prescribed long-term control medications for asthma. They reduce inflammation and mucus production in the airways, making them less sensitive and less likely to react to triggers.
What are the different types of steroids used for asthma treatment?
There are two main types of steroids used for asthma treatment:
Inhaled Corticosteroids
Inhaled corticosteroids are the preferred treatment for people with persistent asthma. These medicines, which are breathed directly into the lungs through an inhaler, mouthpiece or nebulizer, can reduce airway inflammation and help prevent asthma symptoms from starting in the first place. Examples include beclomethasone (Qvar), budesonide (Pulmicort), ciclesonide (Alvesco), fluticasone (Flovent) and mometasone (Asmanex).
Oral Corticosteroids
Oral corticosteroids, such as prednisone or methylprednisolone (Medrol), are used for short-term asthma symptom relief during severe asthma attacks to speed recovery and prevent the need for emergency care and hospitalization. They are also used short-term before switching people to inhaled steroids for long-term control. Oral steroids are effective at reducing inflammation, but they affect the whole body and their long-term use has significant side effects.
What are the benefits of long-term inhaled steroid use for asthma?
Using inhaled corticosteroids for asthma has many benefits:
– Reduces airway inflammation
– Prevents asthma symptoms from occurring
– Reduces frequency and severity of asthma attacks
– Improves lung function
– Reduces need for oral steroid bursts
– Reduces need for emergency care and hospitalizations
– Improves quality of life
– Allows participation in physical activities
– Helps avoid permanent lung damage over time
Multiple studies have shown that early treatment with inhaled steroids can modify the course of asthma in both adults and children by controlling symptoms and airway inflammation. They are the most effective treatment available for long-term asthma control.
What are the potential side effects of long-term inhaled steroid use?
Inhaled steroids are generally safe when used as prescribed. Because they are administered directly to the lungs, only a small portion of the medication enters the bloodstream so systemic side effects are minimal.
However, some potential side effects can occur, particularly at higher doses. Monitoring with your healthcare provider helps balance effectiveness against potential risks.
Potential side effects include:
– Increased risk for infections. Inhaled steroids could potentially slightly increase the risk for sinus infections, thrush (candida infection in the mouth and throat), and pneumonia. Proper inhaler technique and rinsing your mouth after use can help prevent thrush.
– Easy bruising. Long-term use of inhaled steroids may result in a loss of collagen under the skin, resulting in thin skin that bruises easily.
– Suppressed growth. Some studies have shown children may grow more slowly than expected when taking inhaled steroids regularly. Monitoring growth routinely allows early detection of any issues.
– Bone loss. There is a small risk of decrease in bone mineral density. This is generally not a concern for otherwise healthy children using low-to-medium dose inhaled steroids. Those at higher risk can have periodic bone density scans.
– Eye problems. Long-term use has been associated with an increased risk of cataracts and possibly glaucoma. Eye exams can monitor for any changes.
– Adrenal suppression. This is when the adrenal glands produce insufficient cortisol, an important hormone in the body. However this is rare with inhaled steroids when used correctly for asthma.
Any benefits of inhaled steroids far outweigh the small risks when they are carefully monitored and the lowest effective dose is used. Discuss any questions or concerns with your healthcare provider.
What steps can you take to minimize side effects from inhaled steroids?
You can work with your healthcare provider to minimize potential risks when using inhaled steroids:
– Use proper inhaler technique to ensure the medication reaches the lungs rather than the mouth and throat. Ask your provider to review your technique regularly.
– Rinse your mouth after each dose. This helps remove leftover medication and prevents thrush.
– Use a spacer device with your inhaler if prescribed. The spacer ensures more medication reaches your lungs.
– Take the lowest effective dosage. Work with your provider to determine the most appropriate dose to control your asthma with the least amount of medication.
– Monitor your growth and eye health. Have regular exams to help detect any issues early.
– Supplement with calcium and vitamin D if you have bone density concerns.
– Treat any infections promptly. See your provider if you have signs of sinus infections or oral thrush.
– Carry a steroid card and wear a medical ID. These identify you as a steroid user in case of a medical emergency.
– Avoid tobacco smoke exposure. Smoking reduces the effectiveness of inhaled steroids.
Using inhaled steroids with these precautions will allow you to gain the benefits of controlling your asthma while minimizing the risk of side effects.
What happens if you suddenly stop long-term inhaled steroid treatment?
People who take inhaled steroids for asthma control should never suddenly stop their treatment. Stopping inhaled steroids, especially if you have been on a high dose, can cause problems including:
– Rebound inflammation and narrowing of the airways. This makes asthma symptoms get worse.
– Increased mucus production and coughing.
– An asthma attack, which could potentially be life-threatening.
– Adrenal insufficiency. Stopping steroids suddenly prevents the adrenal glands from restarting cortisol production quickly enough.
To safely discontinue inhaled steroids, the dose must be tapered gradually under the supervision of your healthcare provider. This gradual decrease gives your adrenal glands time to adjust and prevents worsening of your asthma. If your provider recommends discontinuing your inhaled steroids, follow their instructions carefully.
How do you stop oral steroids safely after a severe asthma attack?
Oral steroids, such as prednisone, are often used to help speed recovery from a severe asthma attack. Although they are usually only prescribed for one to two weeks, stopping them abruptly can also trigger problems.
To safely come off oral steroids:
– Never stop them suddenly without medical supervision. Tapering is necessary.
– Follow the tapering schedule provided by your healthcare provider. Typically, the dose is reduced gradually over one to three weeks.
– If you develop symptoms as the dose is lowered, contact your provider. The tapering schedule may need to be slowed.
– Closely monitor your breathing and asthma symptoms when coming off oral steroids.
– Make sure you have enough of your regular long-term asthma controller medication available. Use it consistently as directed.
– Follow up with your healthcare provider within five to seven days of finishing the oral steroids. They will want to re-evaluate your asthma control.
With close monitoring and appropriate medication adjustments, your asthma should remain controlled without needing further oral steroid bursts. Discuss any concerns with your provider.
Can inhaled steroids lose effectiveness or stop working over time?
In some people, inhaled steroids may lose some effectiveness controlling asthma symptoms over the long term. This is known as steroid insensitivity or resistance. Reasons it can develop include:
– Inadequate steroid dose. The inhaled steroid dose may be too low to fully control airway inflammation. A higher dose may be needed.
– Poor inhaler technique. Not using inhalers correctly prevents the medication from reaching the lungs effectively.
– Environmental triggers. Ongoing exposure to allergens or irritants can perpetuate airway inflammation. Avoiding triggers can help.
– Smoking. Tobacco smoke causes inflammation that reduces inhaled steroid effectiveness. Quitting can help restore their benefits.
– Viral infections. Colds, flu and other viruses incite inflammation in the lungs despite steroid treatment.
– Medication interactions. Some medications may interfere with steroid metabolism and absorption.
– Genetic differences. Gene variations affecting drug metabolism could decrease inhaled steroid responsiveness.
– Structural airway changes. Chronic inflammation triggers remodeling and thickening of the airways over time, making them less responsive to treatment.
If your asthma seems poorly controlled with your current inhaled steroid treatment, speak with your healthcare provider. They can help determine if increasing the dosage or adding other medications could help overcome steroid resistance. Other asthma treatments are also available when steroids are not sufficient.
What are the effects of long-term oral steroid use for asthma?
Because of their many potential side effects, oral steroids such as prednisone are not recommended for regular long-term asthma treatment. However, some people with severe asthma may periodically require long-term oral steroid use despite standard therapies to help control their symptoms.
Potential long-term effects of chronic oral steroid use include:
– Adrenal suppression leading to adrenal crisis risk
– Osteoporosis and increased fracture risk
– Muscle weakness
– Cataracts and glaucoma
– Hypertension
– Diabetes
– Susceptibility to infections
– Impaired wound healing
– Thinning skin and easy bruising
– Emotional changes and mood disorders
People on long-term oral steroids require close monitoring for signs of these adverse effects along with preventive measures to minimize risk. For example, taking calcium and vitamin D supplements can help counteract the effect of steroids on bone loss and fracture risk.
However, the goal is to keep oral steroid use to a minimum by optimizing other asthma treatments. Alternatives like monoclonal antibodies that target specific inflammation pathways in the lungs are sometimes used to replace or reduce oral steroid dependence.
What are biologic medications for asthma treatment?
In recent years, newer asthma treatments called biologics have been developed that specifically target the underlying inflammatory processes that cause asthma. They are given by injection or infusion. Biologics currently approved for certain types of severe asthma include:
– Omalizumab (Xolair) blocks immunoglobulin E (IgE) antibody involved in allergic asthma
– Mepolizumab (Nucala) and reslizumab (Cinqair) block interleukin-5 (IL-5) cytokine that activates eosinophils implicated in eosinophilic asthma
– Benralizumab (Fasenra) binds to the IL-5 receptor on eosinophils and depletes these cells
– Dupilumab (Dupixent) blocks interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways that drive inflammation
Although expensive, adding these biologics has been shown to reduce asthma attacks and oral steroid dependence in people with the appropriate type of asthma not fully controlled by other medications. More research is needed to better define their long-term impacts and safety. Used appropriately under medical guidance, they offer promise for improving asthma care in the future.
Conclusion
Corticosteroids have revolutionized the treatment of asthma since their introduction over 50 years ago. When used properly, the benefits of inhaled steroids clearly outweigh the risks for most people with persistent asthma. They are the most effective medications currently available for controlling asthma long term.
However, people taking inhaled steroids need monitoring for potential side effects and should use the lowest effective dose for their level of asthma severity. Consulting with an asthma specialist is recommended when asthma is not easily controlled with conventional medications. Newer biologic treatments may allow further reductions in steroid dependence for some patients.
With chronic use of inhaled corticosteroids, risks can be minimized through measures like rinsing the mouth after use, avoiding smoke exposure, and taking calcium and vitamin D supplements. People using steroids for asthma control should never stop them suddenly without medical advice.
Asthma treatment continues to evolve with expanding knowledge and new medications. With the help of their healthcare providers, people with asthma can find the best options for gaining control over their symptoms while reducing medication side effects and risks. Consistent monitoring and open communication are key to optimizing asthma management for the long term.