Oral Corticosteroids (OCS) for Asthma
Oral corticosteroids (OCS), sometimes called oral steroids, are medicines that reduce swelling and inflammation in the body. They are prescribed as pills or in liquid form to treat an asthma attack. They are also used to treat severe or uncontrolled asthma.
OCS are available by prescription only. They are not a quick-relief or rescue medication. People who experience an asthma attack should continue taking their quick-relief albuterol inhaler to calm symptoms as needed.
Steroid medications are man-made drugs. They are modeled after natural steroid hormones in the adrenal glands of the body. They can stop inflammation from getting worse, regulate the immune system, and reduce the risk of severe asthma attacks.
OCS are affordable medications. Asthma patients are typically prescribed a short course of OCS (also called a “burst”) to take for 5-7 days. (The length of your short course may vary depending on the severity of your asthma.)
The medication is considered very effective at stopping symptom flare-ups. It can reduce emergency department visits and hospitalizations for asthma. But if you find you frequently need OCS for asthma, this is a sign of poor asthma control. Review your asthma medication treatment plan plan with your doctor or see an asthma specialist for more comprehensive care.
OCS are different from inhaled corticosteroids (ICS). With ICS, you breathe in the medicine using an inhaler. ICS usually have fewer side effects. OCS are also not the same as anabolic steroids, which are sometimes misused in bodybuilding.
Why are oral steroids used for asthma symptoms?
Asthma is caused by inflammation. The airways become inflamed, sometimes by allergens and irritants, and then narrow, making breathing difficult. It causes symptoms such as shortness of breath, chest tightness, coughing and wheezing.
OCS work to reduce airway inflammation and calm symptoms. This is why they are often used for acute asthma symptoms, asthma attacks, or when symptoms are uncontrolled. OCS are also sometimes used for people with chronic obstructive pulmonary disease (COPD) flares.
If asthma is not well-controlled with ICS or other controller medications, then long-term OCS may be warranted. Long-term OCS can help patients gain better control of their asthma, although it’s often a sign of severe asthma.
OCS treatment is not without health risks. Short-term and long-term OCS use come with the potential for serious side effects.
What are some commonly prescribed oral corticosteroids?
The most common oral steroids prescribed to people with acute asthma symptoms are:
- dexamethasone
- prednisone
- prednisolone
- methylprednisolone
What are some commonly prescribed oral corticosteroids?
The most common oral steroids prescribed to people with acute asthma symptoms are:
- prednisone
- prednisolone
- methylprednisolone
- dexamethasone
What’s the difference between OCS and inhaled corticosteroids (ICS)?
Inhaled corticosteroids and oral corticosteroids both address airway inflammation. OCS target the whole body, while ICS focuses on the airways. OCS come in doses that are 10 times more potent than ICS. These factors are why OCS has a higher risk of serious side effects.
The key points to remember about OCS and ICS for asthma treatment:
- Oral corticosteroids offer quick relief and treat severe asthma attacks.
- Inhaled corticosteroids are intended to help you maintain asthma control.
How often can I take oral corticosteroids for asthma?
Your doctor will typically prescribe OCS to take for a short time – typically 5-7 days. You may start with several OCS tablets and then gradually lower the dose each day.
Needing a course of OCS more than two times a year suggests you have poorly controlled asthma. Work together with your doctor to develop a treatment plan that keeps asthma symptoms in check. Most patients do not need OCS for asthma control.
When can I stop oral corticosteroid treatment?
Your doctor will decide when it’s safe to stop. The length of OCS treatment may depend on how your asthma is responding to the medication. Check in with your doctor regularly during treatment and discuss how you’re feeling while taking OCS.
Do not stop or adjust OCS treatment on your own, especially if you are taking the medication long-term (several weeks or more). You may need to taper off OCS use under your doctor’s supervision. Stopping too quickly can cause withdrawal symptoms.
How do I know if I am using oral steroids too often?
OCS are very effective but some people with asthma may develop a reliance on them. They may want to continue taking OCS to keep their asthma under control. But these medications are not meant for long-term daily use unless absolutely necessary.
OCS overuse is defined as when you take the medication at a dose or duration that increases the risk of adverse effects without a clear benefit. How much is too much? This is a conversation you should have with your doctor to decide what’s best for your asthma.
The overuse may occur when you:
- take more than 2 courses or bursts of OCS per year, especially for asthma symptoms – this is a sign of poor asthma management and control;
- take OCS daily or regularly for more than 3 months, particularly at high doses, and without a cler plan to stop
Additional signs you’re using OCS too often:
- Your asthma feels uncontrolled unless you’re on OCS.
- Side effects are showing up: weight gain, trouble sleeping, mood changes, higher blood pressure or blood sugar, thinning skin, or frequent infections.
You may need to adjust your treatment plan instead of continuing to rely on OCS. Most people with asthma can keep their symptoms in check with other medicines and treatments. These may include advanced medications such as biologics.
What are the side effects of oral steroids used for asthma?
OCS are commonly prescribed to treat severe asthma flare-ups. They offer benefits, but using them too often can harm your health. Their use adds up over time, with a risk of potentially serious side effects.
You may need to balance the benefits vs. risks of taking OCS in a shared decision with your doctor.
Potential side effects from short-term OCS use
- Weight gain, particularly in abdomen, face or neck
- Eye problems
- Muscle weakness
- Insomnia and sleep problems
- High blood pressure
- Elevated blood sugar levels
- Swelling in lower legs
- Gastrointestinal issues (heartburn, nausea)
- Mood changes and irritability
- Depression and anxiety
Potential side effects from long-term OCS use
- Skin thinning and easy bruising
- Osteoporosis and bone loss or weakness
- High blood pressure and cardiovascular risks
- Diabetes onset
- Slow growth in children
- Immune system suppression and increased infection risk
- Adrenal gland suppression and hormonal imbalance
- Glaucoma and cataracts
Always discuss any side effects with your doctor after starting therapy. If you often need OCS for asthma, find out if alternative treatments are available.
Understanding OCS Side Effects
Understanding OCS Side Effects: for HCPs
There are several asthma assessment tools you can use to determine if your asthma is in control or not:
Questions & answers (Q&A) on OCS for asthma
Oral corticosteroids are prescribed to people who are experiencing sudden asthma symptoms or an asthma attack. Here are some common questions about OCS. If you have a question that you would like to see answered below, please email our editor.
Reviewed by:
Purvi Parikh, MD, FACAAI, is an adult and pediatric allergist and immunologist at Allergy and Asthma Associates of Murray Hill in New York City. She is on faculty as Clinical Assistant Professor in both departments of Medicine and Pediatrics at New York University School of Medicine.
