Understanding OCS Side Effects: for Healthcare Professionals

A doctor in a white coat writes a prescription while holding a pill bottle, with a stethoscope draped around their neck. Only the doctor's hands and partial torso are visible.

A short course or “burst” of oral corticosteroids (OCS) can help people who are experiencing severe respiratory, allergic or skin symptoms. This includes people having an asthma attack or living with severe symptoms. It includes people with severe eczema, urticaria or psoriasis flares. And it includes people with severe allergic rhinitis and sinusitis.

New research shows using OCS too often or for too long can cause serious side effects, both in the short term and later in life. That’s why it’s important to limit OCS use when possible. Today, there are many new treatments available. They treat severe or hard-to-control asthma, allergies, eczema, and similar conditions. These options can help reduce or even replace the need for OCS.

If a patient needs OCS often or regularly, it might be time to reevaluate their treatment plan. They may need extra support to stick with their management routine. Think beyond the burst! Look for long-term solutions. You can help patients better manage their conditions, while keeping OCS use to a minimum.

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How Prevalent is OCS Overexposure?

It’s important to understand how often patients take oral corticosteroids (OCS). This helps healthcare providers to manage OCS treatment now and understand the risks of side effects over time.

Asthma is one of the most common conditions for OCS treatment. Research shows that about 1 in 4 people with asthma, no matter how severe, has needed an OCS prescription in a single year. For those with severe or hard-to-control asthma, that number is much higher, ranging from 46% to over 92%. One study found that nearly 1 in 4 patients with uncontrolled asthma needed OCS three or more times in one year.

This shows how much patients with asthma, especially those whose disease isn’t well-managed, rely on OCS. That’s why it’s important for healthcare providers to check in often with their patients on asthma control.

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Signs of uncontrolled asthma

Healthcare providers should assess asthma control with patients at every appointment. They should also check how well they are adhering to the treatment plan.

For asthma, this means taking daily prescribed controller inhalers. The Rules of Two® is a helpful tool for patients and providers to assess asthma control. The questions to ask include:

Do you take your quick relief inhaler more than two times a week?
Do you wake up at night with symptoms more than two times a month?
Do you refill your quick-relief inhaler more than two times a year?
Do you use oral corticosteroids (such as prednisone) two or more times a year for asthma flares?
When you have asthma symptoms, does your peak flow vary more than 10 (20%) of baseline?

Healthcare providers also should ask patients:

Have you had one or more asthma flares requiring a call to 911, emergency room visit, urgent care visit or hospitalization in the past year?
Do you struggle with everyday activities: exercising, household chores, or playing with children?

If a patient answers “yes” to any of these questions, it is a sign their asthma is not well controlled. For primary care providers, you may want to refer the patient to an asthma specialist. For allergists and pulmonologists, it could be time to update the patient’s Asthma Action Plan.

If you treat a patient with uncontrolled asthma, review why the treatment plan is not working. Is your patient relying on OCS to manage symptoms? Ask if the patient is getting an OCS prescription at a hospital or emergency department. Explain the risks and side effects of long-term OCS therapy.

Short Term OCS Side Effects

Eye Pressure	Fluid Retention	High Blood Pressure	Mood Issues	Weight Gain
Elevated eye pressure (glaucoma)	Fluid retention (causing swelling in lower legs)	High blood pressure	Problems with mood, stress, memory, and behavior	Weight gain (abdomen, face, and neck)

Long Term OCS Side Effects

Cataracts	High Blood Pressure	Infections	Bone Issues	Bruising	Suppressed Adrenals
Cateracts (clouded vision)	High blood sugar (can trigger or worsen diabetes)	Infections	Osteoporosis/bone fractures	Thin skin, bruising, slower wound healing	Suppressed adrenal gland production

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Oral Corticosteroids Health Care Pros and Cons

OCS treatment is an important tool for healthcare providers. It can help treat a variety of respiratory, allergic and skin conditions. They can reduce inflammation that cause symptoms in the body. Most patients take OCS treatment in short bursts – 3-5 days – to treat acute symptoms.

Definition of oral corticosteroids

Oral corticosteroids (sometimes called oral steroids) are synthetic hormones. They mimic the effects of natural steroid hormones in the body. These systemic corticosteroids work by reducing inflammation and suppressing the immune system.

Patients may confuse OCS with anabolic steroids. Anabolic steroids are taken to build muscle and enhance athletic performance. OCS treatment is also different from inhaled corticosteroids (ICS). Patients breathe in ICS using an inhaler or nebulizer to treat asthma.

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Indications and Benefits for Oral Corticosteroids

Oral corticosteroids are useful for treating a host of conditions. These include:

Asthma
COPD
Allergies (including allergic rhinitis or “hay fever”)
Nasal Polyps
Sinusitis
Eczema
Hives
Contact Dermatitis (such as from exposure to poison ivy)
Psoriasis
Autoimmune diseases such as inflammatory bowel disease, systemic lupus erythematosus, or rheumatoid arthritis

In most cases, OCS should be used for short-term treatment of acute exacerbations. They can provide quick relief from the inflammation and swelling due to flare-ups of symptoms. But that doesn’t mean they should be used without caution, given the risks they pose, especially with repeat use.

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Oral corticosteroid adverse effects

Even though oral corticosteroids are effective in treating inflammation, it is important to consider the potential adverse effects or side effects.

Short-term side effects of OCS treatment include:

Swelling of the lower legs
High blood pressure
Eye pressure
Weight gain, particularly in abdomen, face or neck
Muscle weakness
Insomnia and sleep problems
Elevated blood sugar levels
Stomach issues (heartburn, nausea)
Mood changes and irritability
Depression and anxiety

In many people, these side effects can be stopped or reversed when OCS treatment ends.

Long-term effects of OCS treatment include:

Neuropsychiatric issues including anxiety and depression
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
Skin conditions including thin skin, bruising, and wound healing challenges
Adrenal gland suppression
Gastrointestinal issues including gastritis, ulcers, and bleeding

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Safe Use of Oral Corticosteroids

When prescribing OCS, review the following with patients:

Oral corticosteroids should only be taken under the guidance of a healthcare professional.
Different names for OCS medications: prednisone, prednisolone, methylprednisolone, and dexamethasone.
The prescribed dosage and treatment duration to reduce the risk of OCS side effects.
Why it is important to track blood pressure and blood sugar levels while taking OCS.
Patients should also be aware of the potential for interactions with other medications.
Reinforce to patients they should contact their provider if adverse effects develop.

Monitoring and managing side effects

It’s very important to monitor patients for side effects after prescribing OCS treatment.

Conduct regular follow-up appointments to check for side effects.
Track weight gain, high blood pressure, blood sugar levels, thin or bruised skin, and other potential side effects.
Adjust the dosage or treatment duration as needed to reduce the risk of side effects.
Educate patients on how to manage side effects. This may include taking medication to control blood pressure.

Oral corticosteroid restrictions and precautions

Some patients should not take OCS. They include:

Patients with certain medical conditions, such as uncontrolled high blood pressure and diabetes.
Patients with a history of allergic reactions to oral corticosteroids.

Others can take OCS but with certain precautions, such as under the guidance of a healthcare provider. They include:

Patients with a history of taking steroid injections or topical corticosteroids
Pregnant or breastfeeding women

Review these restrictions and precautions with patients when prescribing OCS.

Discontinuing or tapering oral corticosteroid treatment

Oral corticosteroids are often prescribed in tapered doses. They should not be abruptly stopped. This can lead to withdrawal symptoms.

It is important to monitor patients for signs of withdrawal, such as fatigue or joint pain. Schedule regular follow-up appointments after prescribing OCS. Review the effectiveness of treatment and check for side effects. Then make a plan for discontinuing or tapering OCS treatment.

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Enhancing healthcare team outcomes

When prescribing OCS, make sure all other healthcare providers treating the patient are aware of the treatment plan. This should include providers who see patients in the hospital or emergency department.

When all providers are aware of the treatment, they can all monitor its effectiveness and side effects. This can make it easier to determine if changes need to be made to the treatment plan.

Oral corticosteroids carry serious health risks for both the short and long-term. Be sure to stay up to date on the latest research and guidelines for OCS treatment. If patients need repeat courses of OCS, this is a sign their disease management plan may not be working.

When OCS treatment has ended, take a closer look at the patient’s medical condition. Is the management plan effective? Consider steps to help prevent the need for OCS in the future.

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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