What They Are: Oral steroids, or "oral systemic corticosteroids," is the medical term for a steroid medicine taken by mouth that has an effect on the whole body (systemic, or system-wide). This is an important distinction from inhaled steroids, because one of the things that makes inhaled steroids a preferred long-term asthma treatment (and safer) is that they act only on the airways, and not the rest of the body. But steroids in pill or liquid form are sometimes used as quick-relief asthma medicines too.
Oral steroids can play a key role in asthma control, when used sparingly. Oral steroids are sometimes given in the ER to help prevent a worsening of a moderate to severe asthma attack. They can take as long as 4 hours to reach maximum effectiveness, but they can speed resolution of airflow obstruction and reduce the rate of relapse, which can be quite beneficial.
How They Work: Oral steroids reduce inflammation throughout the body, not just in the airways. But in the airways, they reduce swelling and decrease mucus, both of which make breathing easier. They do this by suppressing the immune response in your body. They do not act as a bronchodilator.
The Effects: Once oral steroids take effect, there will be a speeding up of the "return to normal" from the asthma attack, with a lessening of asthma symptoms, such as wheezing, coughing, chest tightness, and shortness of breath. In addition, as mentioned above, they will help prevent a relapse, or recurrence, of future asthma attacks. This is important because allergic asthma sometimes follows a pattern of getting better after using a quick-relief inhaler, but then worsening again a short time later. If this continues, it can even progress to a life-threatening condition called status asthmaticus.
Examples: Prednisone is the main type of oral steroid used. Others include prednisolone and methylprednisolone.
Oral steroids come in both tablets and liquid syrup.
Other Important Facts: Oral steroids, because they act on systems throughout the body, do carry a risk of side effects. However, the degree of risk depends greatly on how much of the drug is taken and how often. Limited use of an oral steroid carries very little risk, but this does increase each time another course of treatment needs to be given.
Asthma treatment guidelines recommend that if you need to use oral steroids more than 3 times in a year, then the asthma management plan probably needs to be evaluated and revised.
Common physical side effects of frequent use of oral steroids include the following:
- Potential for growth suppression
- Osteoporosis
- Cataracts
- Myopathy
- Adrenal suppression
- Increased appetite with weight gain
- Development of Cushing syndrome, with moon face appearance, buffalo hump, central obesity with wasting of extremities, atrophy of the skin with the development of stretch marks, and excess hair growth
In addition, there may be psychological effects, such as mood swings and psychotic episodes. High doses of oral steroids can suppress the immune system, making you more susceptible to infection too.
It's also important to understand that the kind of steroids you take orally or in an inhaler for asthma are not the same type that athletes sometimes use to enhance performance. Those are called anabolic steroids and they can have serious side effects. Oral and inhaled steroids for asthma are very close to chemicals found naturally in your body, including cortisol.
Despite the seriousness of some of the side effects described above, most of these effects occur only after being on a high dose of oral steroids over an extended length of time. So, for occasional emergency treatment of an asthma attack, the benefits will probably outweigh the risks of taking oral steroids. Still, if you have questions, be sure to discuss them with your doctor.
In Summary: Oral steroids are sometimes used as a quick-relief medicine for moderate to severe asthma attacks. The first line of defense for asthma flares should always be an inhaled short-acting beta agonist, such as albuterol. But in some cases, the doctor may recommend also taking an oral steroid to help promote a better outcome after an asthma attack.
Sources:
"Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma." NHLBI Guidelines for the Diagnosis and Treatment of Asthma. 28 Aug 2007. National Heart Lung and Blood Institute. 18 Dec. 2007 <http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf>
National Jewish. About steroids (inhaled and oral corticosteroids). Feb 2006. <http://www.nationaljewish.org/disease-info/treatments/long-term/steroids/corticosteroids.aspx>
