What are Oral Corticosteroids (OCS)?
Oral corticosteroids (OCS), sometimes called oral steroids, are medications used to reduce inflammation in the body. They come in pill or liquid form.
OCS can be used for a variety of medical conditions, including respiratory, allergic and skin diseases. They are primarily used to help treat flare-ups of symptoms, such as for an asthma attack.
Here are some examples of OCS:
- prednisone
- prednisolone
- methylprednisolone
- dexamethasone
Steroid medications are man-made drugs modeled after natural steroid hormones in the adrenal glands in the body. They can stop inflammation from getting worse, regulate the immune system, and reduce the risk of a more severe flare-up.
Oral corticosteroids are different from inhaled corticosteroids (ICS). OCS are systemic in that they can treat symptoms that occur across the whole body. ICS are more localized to treat symptoms in the airways. As a result, ICS have a lower risk of side effects.
OCS are also different from anabolic steroids. These are related to the male hormone testosterone and sometimes used for muscle building.
What are oral corticosteroids used for?
Oral corticosteroids are used to reduce inflammation in the body for a variety of medical conditions. They are an inexpensive and fast-acting drug. OCS are often prescribed for short periods, called “bursts,” which is usually 3-5 days. They are given only under a doctor’s supervision.
The medication can come with significant and severe side effects, mainly for those who use OCS long-term.
Asthma
OCS are prescribed to reduce inflammation and swelling in the airways. They are given when asthma symptoms worsen quickly. Doctors prescribe them as a short-term asthma treatment option. This decreases the risk of further complications from an asthma attack. However, two or more courses of OCS per year to treat asthma often indicate uncontrolled asthma.
In severe or uncontrolled asthma, OCS has been used as a form of maintenance therapy to maintain asthma control. Long-term OCS use can result in more severe side effects than short-term use.
Chronic Obstructive Pulmonary Disease (COPD)
Oral corticosteroids are used to treat acute COPD flares. They reduce COPD symptoms by decreasing swelling in the airways. They also reduce mucus production and improve airflow throughout the lungs.
However, it’s important to monitor OCS treatment for COPD. Some research suggests that OCS are linked to a higher risk of adverse outcomes in people with COPD.
Allergies
OCS are not generally prescribed for seasonal or environmental allergies. But they may be considered if symptoms are severe or when antihistamines or topical treatments are not working. They may be prescribed to treat severe asthma flare-ups triggered by allergens.
OCS can sometimes be used after epinephrine to treat a severe allergic reaction, or anaphylaxis. But epinephrine is the first-line treatment. Oral corticosteroids are an adjunct treatment, meaning they can be given only after epinephrine. The combination of OCS and epinephrine is also used to treat bronchiolitis in infants.
Allergic Rhinitis
OCS are prescribed for severe cases of allergic rhinitis. They are given when treatments like antihistamines or nasal sprays are not working. OCS help reduce inflammation in the nasal passages. They also can control symptoms like nasal congestion and red, itchy, watery eyes.
Nasal Polyps
OCS may be used to reduce inflammation in the nasal passages and shrink nasal polyps. They can provide temporary relief from symptoms like nasal congestion.
Sinusitis
Sinusitis is defined as inflammation of the sinuses. OCS may be prescribed for sinusitis when it’s chronic or severe. It may also be prescribed when inflammation does not respond to antibiotics or nasal sprays. OCS reduce swelling and relieve symptoms such as nasal congestion and facial pain.
Eczema
Oral corticosteroids are not a first-line treatment for eczema due to the potential for severe side effects. OCS may be prescribed short-term to quickly reduce inflammation during severe eczema flares. Eczema, also known as atopic dermatitis, is a chronic skin condition. It is characterized by bumpy, itchy patches of skin, inflammation and dry, scaly skin.
Contact Dermatitis
OCS may be prescribed for severe cases of contact dermatitis, especially when the rash is widespread and/or not responding to topical treatments. They are also given when the rash is blistering on the affected skin. OCS can help reduce inflammation and itching.
Urticaria (hives)
OCS may be used to treat severe or acute cases of urticaria (hives). They also may be used to treat chronic urticaria, defined as hives that last longer than six weeks. They are prescribed when symptoms are widespread and/or not controlled by antihistamines. OCS can help reduce inflammation and relieve itching.
Poison Ivy
Poison ivy is a type of contact dermatitis. OCS can be prescribed to treat severe poison ivy reactions. This includes when the rash is widespread and/or not responding to topical medications. It also includes when there’s blistering on the skin. OCS can help reduce inflammation and itching.
Psoriasis
OCS may be used to treat severe flare-ups of psoriasis. They can reduce inflammation and control symptoms like itching and scaling. OCS are not recommended for long-term use as a psoriasis treatment.
How do Oral Corticosteroids Work?
Oral corticosteroids work by helping to reduce inflammation in the body. They do this by acting like a hormone called cortisol, which the body naturally produces to help control swelling and the immune system. When taken as a pill, corticosteroids can…
- Stop the body from making chemicals that cause inflammation.
- Help reduce swelling and fluid buildup in tissues, easing symptoms like pain and congestion.
- Lower the activity of white blood cells (such as eosinophils) involved in the inflammation process. This reduces inflammation.
OCS are helpful for treating conditions like asthma, allergies and skin problems. They are primarily used for a short time. If used too long, they can cause side effects like weight gain, high blood pressure, and a weakened immune system.
OCS are best prescribed for acute flare-ups. They are also for severe inflammation, or when other medicines (like inhaled corticosteroids) are not working.
Oral steroid advantages
OCS can quickly reduce inflammation and other symptoms. They work throughout the body, providing fast relief during severe flare-ups. This makes them useful for conditions that can cause widespread symptoms.
Oral steroid disadvantages
OCS have a higher risk of serious side effects. They are not ideal for long-term use. (People who take OCS long-term should talk with their doctor about other treatments, including medicines known as biologics.)
Oral corticosteroids dose
The dosage of oral corticosteroids depends on the condition and severity of symptoms. It can also depend on factors such as age and overall health. OCS are typically given in a course of 3-5 days, known as a “burst.” For short courses, a high dose is prescribed each day for up to a week and then stopped abruptly.
Long-term use of OCS typically requires gradual tapering off of the medication to avoid complications. This can help prevent complications such as adrenal insufficiency. Adrenal insufficiency is a condition where adrenal glands are suppressed. They cannot produce enough of the hormones cortisol and aldosterone. Tapering off refers to the gradually reducing the OCS dosage rather than stopping abruptly. This is best especially after prolonged use.
It’s important to follow your doctor’s instructions on how to use OCS. This includes appropriate dosage and duration of use.
Oral corticosteroids side effects
It’s important to understand the potential risks of side effects when prescribed OCS. People on a short course of OCS may experience eye problems, weight gain, high blood pressure, high blood sugar, muscle weakness, and mood or behavioral problems. People who use OCS long-term may develop diabetes, osteoporosis, thin skin, an increased risk of infections and reduced hormone production.
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 OCS. Be ready to tell them and your pharmacist about all the medicines you’re taking. (Include herbal or other alternative therapies).
Learn more about side effects of oral steroids.
What is considered overuse of OCS?
Oral corticosteroids have a high rate of success in treating flare-ups of symptoms. As a result, some people may develop a reliance on them. They may want to continue taking OCS to help keep their condition under control. This is OCS overuse.
OCS overuse is when you take oral steroids at a frequency, dose or duration that increases the risk of adverse effects without a clear benefit. The overuse occurs when you…
- take more than 2 courses of OCS per year to treat asthma or other conditions; or
- take OCS daily or near-daily for more than 3 months, particularly at high doses.
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.
When treating asthma, OCS is not meant to serve as a controller or maintenance medication. Safer treatment options are available.
How prevalent is OCS overuse?
A survey by Asthma and Allergy Foundation of America (AAFA) revealed that nearly 85% of people with asthma had used at least one course of OCS in the past year. Of that group, 64% reported two or more courses.
Two or more courses of OCS within 12 months indicate poorly controlled asthma. Patients should consult with their doctor to revise their treatment plan.
How can I prevent OCS overuse?
First, gain an understanding of oral corticosteroids. When should they be used? How do they work? What are side effects? Then, work together with your doctor on finding appropriate treatments. Inhaled corticosteroids are controllers for asthma and topical corticosteroids are for eczema. Ask about advanced medications, such as biologics.
You should also…
- Work closely with an allergist or pulmonologist to optimize long-term control.
- Learn about OCS side effects.
- Follow your treatment plan.
Oral Corticosteroids Questions & Answers (Q&A)
Oral corticosteroids are used by millions of people for many different medical conditions. Here are some common questions about OCS. If you have a question that is not asked below, please email the editor.
Reviewed by:
William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as Medical Director with Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).
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