The Asthma Center

Long term oral corticosteroid treatment

If you are unresponsive to commonly used controller and reliever asthma treatments, you may require long term use of daily or alternate-day corticosteroids. This treatment is used for the most difficult to manage asthma and requires frequent evaluation to assess its effectiveness and side effects. Steroid-sparing treatments can be used often with some degree of success.

In general it is always best to administer the smallest effective dose of a shorter acting oral corticosteroid to reduce the potential risks of side effects. This is best managed through a program of regular office visits where your current symptoms, physical examination, and pulmonary functions all can be analyzed. If you require an acute burst of oral corticosteroids, The Asthma Center specialists recommend that you be seen in follow-up visits within 48 to 72 hours after treatment. This acute follow-up visit is important in evaluating effectiveness of treatment, assessing potential side effects, and planning a dose taper program.

Long acting corticosteroids such as dexamethasone (Decadron®) or any type of slow release injection should be avoided except under extraordinary circumstances. Once this latter type of corticosteroid is injected, it cannot be removed from the body and will slowly be released over weeks or months. Although an injection of corticosteroid may seem convenient, The Asthma Center specialists do not consider its use as a wise approach to the management of asthma when more flexible and safer programs are available.

Long term use of oral corticosteroids can cause problems such as osteoporosis, glaucoma, cataracts, diabetes and loss of body salts and minerals. An unusual but rare complication that can occur with corticosteroid use is aseptic necrosis. This serious bone condition usually affects the hips and may ultimately require surgery. Fortunately the risk of developing aseptic necrosis is very low and the benefits of corticosteroids typically outweigh the remote risk of this condition.

Long term oral corticosteroid use can also cause adrenal insufficiency. The adrenal gland normally secretes vital hormones known as corticosteroids. With oral corticosteroid use longer than a month, the adrenal gland may be suppressed in secreting corticosteroids important for normal body function. Very long courses, especially with high doses, can cause the adrenal gland to stop working completely. The adrenal gland will restart after stopping corticosteroids, but it may take months to years for the adrenal gland to completely recover.