By Purvi Parikh, MD
One of the best defenses that doctors have against severe asthma are oral corticosteroids – often prednisone. This life-saving wonder drug stops an asthma flare in its tracks; it’s effective, easy to take (in liquids or pills) and affordable.
On the other hand, it’s also a very strong medicine that should be used sparingly and wisely.
The list of potential unwanted side effects from oral or injected corticosteroids is daunting, from growth issues and weight gain to anxiety and adrenal problems, but the medicine’s effectiveness often outweighs the dangers. This is particularly true for short-term use. While an injection or a 3-5 day “burst” of prednisone may pose few long-term problems, more than two such treatments over the course of a year changes the picture.
Corticosteroid inhalers such as budesonide, fluticasone, mometasone or beclomethasone are a different story. These essential asthma medications treat the airways and lungs and do not cause the same side effects as systemic or oral corticosteroids. In fact, patients who stop their inhaled corticosteroids due to fear of side effects may end up needing more courses of oral or injectable corticosteroids.
Sometimesoral and injectable corticosteroids are overprescribed. It’s easy to overuse a drug if you get one from your skin doctor, another from your primary care physician, and yet another from an emergency department.
That’s why it’s important to take an active role in your healthcare. Question your doctors about medicines they recommend – especially if it’s prednisone – and be ready to tell them and your pharmacist about all the medicines you have been taking (including herbal or other alternative therapies).
How much is too much? That’s a decision for you and your doctors to make together. Sometimes long-term use of oral steroids is important and worth the resulting side effects.
For many patients with difficult-to-control asthma, however, recent innovations in diagnosis and treatment offer new options, targeting therapy to match specific asthma phenotypes. See a board-certified allergist or pulmonologist to find out about these developments.
Be honest with your doctor about your concerns and fears: Don’t just paint a rosy picture. Studies have shown that patients experience more side effects from their medicines than doctors realize – and may decide for themselves to cut their treatment short. However, too little medicine might not be enough to do the job. Talk about any unusual symptoms you notice while taking a medication, then work together to find a treatment plan that works.
Important facts about corticosteroids:
- Prednisone, and its close cousins methylprednisolone and prednisolone, are corticosteroids, not the anabolicsteroids misused by some athletes to gain strength. Corticosteroids are anti-inflammatory medicines that fight asthma, some allergies, and other inflammatory conditions. A 3-10 day “burst” of oral corticosteroids will usually stop an asthma episode and prevent it from recurring.
- For most patients, more than two bursts a year indicates your asthma may be out of control and you should see a specialist. There are new asthma treatment options that might reduce your dependence on steroids.
- Inhaled corticosteroidsare safe and effective, without the side effects of long-term oral or injected steroids.
- Follow your physician’s orders about how much medicine to take and how long to continue it: Don’t stop or cut back just because you’re feeling better or concerned about unwanted side effects. Call your doctor and ask about adapting the treatment.
- Keep track of the medicines you take – both long-term and short. Use an app or a notebook, and share it with your doctors.
- Be your own best advocate. When a doctor prescribes a medicine, ask why. Ask if there are other alternatives.
Do you wonder about your asthma? You’re not alone. Most patients underestimate the severity of their asthma. They put up with more breathing problems than they should, not realizing that, with proper treatment, they could be largely free of symptoms. If you are waking up at night, using your albuterol quick-relief inhaler more than twice per week or having difficulty walking, talking or playing with your kids, your asthma is uncontrolled.
Find out where you stand. Allergy & Asthma Network, a leading patient education and advocacy organization, has teamed with asthma specialists to develop a simple questionnaire that can help. Visit asthma.chestnet.org and use the Asthma Severity and Control Assessment tool.
Share the results with your doctor and start on the road to better health today.
Purvi Parikh, MD, is an allergist and immunologist with Allergy & Asthma Network. She practices in New York City at Allergy and Asthma Associates of Murray Hill and New York University School of Medicine. She is on the Board of Directors for the Advocacy Council of the American College of Allergy, Asthma & Immunology (ACAAI).