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What Are Inhaled Steroids and Who Needs Them?

 

Inhaled steroids reduce and prevent inflammation, swelling, and mucus build-up in your airways and lungs. By doing so, they help prevent asthma attacks and keep you breathing easier, allowing the proper amount of oxygen to get into your lungs and then your bloodstream.

Not everyone with asthma or chronic obstructive pulmonary (lung) disease (COPD) needs an inhaled steroid drug, or for that matter any medicine to help them breathe. Sometimes, prevention (especially quitting smoking) and lifestyle adjustments work well enough that you won’t need to take a medicine. But most people with these conditions – including children with asthma – probably will need some kind of medicine, and an inhaled steroid drug in particular.

If you or your child have persistent asthma, your doctor is very likely to prescribe an inhaled steroid. Persistent means you have attacks or symptoms more than twice a week, or attacks that interfere with normal activity. Even if the attacks or symptoms are mild, your doctor is likely to advise that you try to prevent them by using an inhaled steroid.

If you have only intermittent and/or mild attacks that don’t really interfere with leading a normal life, your doctor may suggest you try to control the symptoms with a fast-acting reliever as needed and not take an inhaled steroid unless your symptoms worsen. One sign of that would be if you find that you are using your quick-relief inhaler more than three or four times a week.

Children usually need lower doses of all asthma drugs. It’s important therefore to know the dose of an inhaled steroid that is right for your child. Notably, recent studies show that inhaled steroids do not actually affect the underlying disease in children. Asthma persists despite treatment, though symptoms are reduced. Most importantly, when treatment is stopped, symptoms can worsen.

Inhaled_Steroids

Steroids? Aren’t They Dangerous?

The inhaled steroids used to treat asthma and chronic obstructive pulmonary (lung) disease are not the same as the anabolic steroids that athletes take to enhance performance or strength. So you don’t need to worry that the drugs will cause the side effects linked to anabolic steroids.

You may also have heard that taking steroids can stunt your child’s growth. Recent long-term studies show that inhaled steroids can slow growth in children in the first year of treatment but their final adult height is not affected. Your child’s growth can be stunted if their asthma is poorly controlled. So, effectively, your child probably has a greater chance of not reaching their full potential height if they don’t use a steroid inhaler than if they do.

Likewise, there’s no evidence that inhaled steroids can affect your behavior or make you more aggressive. Again, aggressive behavior has been linked to anabolic steroids but not to the steroids used in inhaled medicines for asthma or COPD.

All that said, doctors advise that children always use the lowest dose of inhaled steroids that helps them.

At the other end of the age spectrum, inhaled steroids have been linked in some studies to an increased risk of osteoporosis, or weakening of the bones. But experts continue to debate whether this research is valid and many studies have found no link between using inhaled steroids and loss of bone density or a higher risk of bone fractures.

Still, if you are over 50 and use inhaled steroids, you may want to take calcium and vitamin D supplements and have occasional bone density measurements as a precaution.

Regular use of inhaled steroids by people with chronic obstructive pulmonary disease (and especially those with emphysema) is more controversial than use by people with asthma. There is simply less evidence that the drugs provide enough of a benefit for people with COPD. In addition, the FDA has not specifically approved treatment with inhaled steroids for chronic obstructive pulmonary (lung) disease. Still, studies indicate that these medicines help many people with COPD -yielding better health status overall and fewer attacks of mucus build-up and labored breathing.

If you have mild chronic obstructive pulmonary (lung) disease, your doctor may discourage regular use of an inhaled steroid. If you have moderate to severe COPD, however, your doctor could advise trying one for several months to see if it helps. He or she may also prescribe a short-acting relief medicine, and well as other drugs.

Possible Side Effects of Inhaled Steroids

Relatively Minor:
Usually go away in time or are short-lived

■ Mouth or throat irritation
■ Mouth or throat infection
■ Cough
■ Hoarseness, sore throat
■ Headache
■ Nausea or vomiting

Not so Minor:
These are quite rare but can be dangerous

■Eye problems (associated with very high doses)
■ Thinning of skin
■ Bruising
■ Bone thinning

Correct Diagnosis is Important

Diagnosing asthma and COPD (chronic obstructive pulmonary disease) is pretty straightforward. Your doctor will first want to rule out other causes of your symptoms and then assess how severely you are affected. That will in turn determine your treatment, including the drugs you may need.

In addition to questions about your medical history, symptoms, and lifestyle habits, you will likely undergo tests of your lung function. For example, a spirometry test measures lung capacity by assessing how much and how fast you can blow air out of your lungs after you take a deep breath. During the test, the doctor may also give you an inhaled bronchodilator to see if it helps your lungs function better. If it does, that’s an indication that you have asthma.

To diagnose COPD, in addition to the spirometry test, your doctor may order a chest X-ray and others tests that will measure the oxygen and carbon dioxide levels in your blood and other aspects of your lung function.

If you are an adult who never suffered from asthma or allergies – and you are not a smoker – a doctor will want to determine if your symptoms are the result of other causes. It’s uncommon, but non-smokers do develop chronic obstructive pulmonary (lung) disease.

Side Effects

Like most medicines, the inhaled steroids can cause side effects. The most common are mouth and throat irritation, cough, and hoarseness. These side effects are quite common but are usually minor and tolerable. Rarer are mouth or throat infections, which can be prevented by using a spacer device and thoroughly rinsing your mouth with water after each inhaler use.

One inhaled corticosteroid, triamcinolone (Azmacort), carries a special “black box” warning. The FDA added the warning to make physicians aware that it can be dangerous to switch patients who have been on large doses of oral steroids to triamcinolone (or possibly any inhaled steroid). In some rare cases, patients who have been switched have died due to a condition called adrenal insufficiency. Make sure to tell your doctor if you’ve been taking steroid pills.

Finally, if you are pregnant and have asthma you should continue to take your inhaled steroid. If your asthma is not well controlled, the oxygen level in your blood may be lower and your baby would also be getting less oxygen.

 

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