The Asthma Center

Steroid phobia

Inappropriate fear of corticosteroid use in asthma treatment without a balanced view of the issues involved is one way to define steroid phobia. The steroids used in asthma treatment are corticosteroids. These steroids have anti-inflammatory effects. They are not the androgen-like muscle building steroids that have had a bad reputation for side effects among athletes and body builders.

Skilled physicians who prescribe corticosteroids have a deep respect for the potential risk of side effects. On the other hand, physicians who struggle to treat these difficult chronic medical problems also respect the extraordinary benefits of corticosteroids in effectively treating asthma or improving the quality of life when other treatments have failed.

Although oral corticosteroids have significant generalized effects on the body, newly developed inhaled corticosteroids are very effective when directly inhaled into the lungs, sprayed into the nose, or dropped into the eyes. Yet they result in little general absorption or side effects when used in low doses. They have been specifically designed to be effective in low doses and are quickly inactivated by your body's metabolism. When using any corticosteroids, you should be monitored every few months to check for early signs of side effects and to reevaluate the doses of medications. For example, children using inhaled corticosteroids should be measured by the stadiometer (a highly accurate height measuring device) in the doctors' office and charted for growth acceleration every few months in order to detect those unusual cases in which inhaled corticosteroids might affect a child's growth rate.

Oral corticosteroids are another matter. Short term use (a few weeks or less) is hardly ever associated with long term side effects. On the other hand, long term treatment (many months to years) is often associated with weight gain, thinning of the skin, osteoporosis, and interference with linear growth in children. The use of alternate-day corticosteroid treatment or steroid sparing medications may allow your physician to lower the total dose of corticosteroids administered, thus lowering the potential for side effects over time. In general, the higher the dose and/or the longer the course of treatment, the greater the chance of side effects.

So why use oral corticosteroids at all? Every asthma specialist in the U.S. and the western world today uses oral corticosteroids to treat select individuals. The potential for dying during an acute asthma attack or suffering a very poor quality of life due to constant severe asthmatic symptoms clearly outweighs the potential risk of oral corticosteroid side effects.

In fact, many of the corticosteroid side effects seen by The Asthma Center specialists have been, in part, a result of receiving suboptimal care or relying primarily on oral corticosteroids to control severe symptoms. Many of these individuals were not in an optimal program that offered ongoing monitoring for corticosteroid side effects, nor were their asthma medications optimized to receive the lowest dose of corticosteroids in combination with other asthma medications that would permit good control of symptoms.