Asthma medicine side-effects under the spotlight

Oral corticosteroids tablets such as prednisone, prednisolone and dexamethasone can be lifesavers for many with asthma, helping to open the airways when other regular treatments fail, but experts are warning we could have an overuse problem resulting in significant and long-term side-effects. 

For World Asthma Day (Tuesday, May 3), three Australians living with asthma have shared their personal experiences with commonly prescribed oral corticosteroids.  

Alongside the benefit they’ve gained in controlling severe asthma symptoms, their stories reveal worrying side effects like reduced density of bones and teeth, skin irritations, extreme hunger and weight gain, insomnia, moodiness, constipation and more. Experts add that they also increase the risk of heart disease, blood clots, cataracts and depression. 

Leaders in respiratory health, including Asthma Australia and Asthma WA, are calling on the community to share their experiences with oral corticosteroids by taking a short survey, open until 16 May, available here. 

Dr Desley Hegney, Mark Mathers and Kim Randle all endure the daily challenges of severe asthma and have all been hospitalised at times due to their severe asthma symptoms.  

Their use of oral corticosteroids has probably saved their lives – but their repeated use is associated with considerable and quite uncomfortable harm. 

For Dr Hegney, who relies on oral corticosteroids several times a year, the side effects are far reaching.  

“So it’s not just your mood or your blood sugars, but it’s also your bowel, your heart, your blood pressure, and all of that, so it has a whole effect on your body – it’s not a nice effect, I don’t think, except on your lungs,” Dr Hegney explained. 

“Sometimes you look at the medication and think, ‘Is it really worth it? Is the cure worse than the disease?’ and I suppose in this case it isn’t, because if you don’t have it, you could die. 

“Once it kicks in, it does make a huge difference to how you manage – within 24 hours, you go from having lots of puffers and feeling terrible, to being able to breathe again without much help, so you have to take it because it does work.” 

For Mark Mathers, 55, long-term use of oral corticosteroids has resulted in brittle bones and teeth – he suffers loss of bone density known as osteopenia and has fillings in all of his teeth.  

As a 40-year-old, he was taking oral corticosteroids daily for a year, which caused considerable weight gain, a widely reported side effect. The drug has also caused him increased appetite, which also contributed to his weight gain, and insomnia. 

“If the puffers aren’t working, then oral corticosteroids are literally the next step. The benefits are it does get you back to normal pretty quickly, but it has its downsides,” Mark said.  

“I know for myself, at the right dose per day for a week, it feels like all my other aches and pains just disappear, but I have to remember that this is short term… If I’m going to be on it for too long, then it’s not going to be good for the body.” 

For Kim Randle, oral corticosteroids have been included in her asthma treatment plans for about 30 years, despite the side effects. 

When needed, she takes the medicine in conjunction with her preventers to counter the onset of a serious asthma flareup, in her case triggered by weather changes, bushfire smoke, and colds and flu. 

“When I know the puffer hasn’t worked, or if I know I’m getting a cold or a flu, or I don’t feel well; especially if I start coughing at night, I know that something is not right,” Kim said. 

“You get grumpy and angry – and my doctor knows all that – but it’s a case of, ‘How much can we give before you reach that point of going over the edge with being grumpy?’ because it sets you off, it really does.  

“Is it a good drug? I hate it, but [sometimes] it’s the only drug out there that opens up my airways, so I have no other choice.” 

Kim also notes that dealing with serious asthma has depleted not only all her sick leave but also her general annual leave, an unrecognised side effect.   

Oral Corticosteroids are powerful anti-inflammatory medicines that work to dampen the immune system, reducing the swelling, redness and mucus production in the lungs. 

Respiratory physician Professor John Blakey notes their value and also their downsides. 

“It’s very important that people with asthma receive the right dose of corticosteroid for the right duration for the right reason. Unfortunately, they are not always prescribed prudently,” Professor Blakey explained.  

“The avoidable side-effects are common and can be debilitating. The positive aspect to this situation is that we have many effective interventions that reduce the need for tablet steroids.” 

Clinical nurse consultant Brooke Kyle explained the need for greater awareness of the side effects. 

“It is common for people to be dispensed many more steroid tablets than are required for a prescribed short course. This might mislead people into thinking it is safe to take extra whenever they feel a little worse. It is important that we support people to understand what side effects tablet steroids have,” Ms Kyle said. 

Mark has worked hard to counter the effects of ongoing use of oral corticosteroids though regular weight training – which he believes has for 20 years halted any further degrading of his bones – by being disciplined in his diet, and taking the drug, when required, in the mornings. 

“Our bones and muscles get stronger by working against resistance, so body building has helped keep my bones healthy, and the lifestyle that I follow because of that has kept me healthy throughout the many years I’ve been doing it,” he explained. 

“If they could find another alternative that could have the benefits without the long-term side effects, it’d be amazing. I think that’d be a game changer in the asthma world.” 

There is evidence to suggest that some people with asthma are being overprescribed oral corticosteroid tablets as part of their asthma management. Many of these people may not be aware of the short-term and long-term side effects that can come with overuse of these medicines.   

Asthma Australia and Asthma WA want to change this and work with consumers to have informed conversations with their health care provider, with the view to using this medicine less. But we need to better understand this issue before we can tackle it.  

We’re inviting people with asthma to complete a survey about oral corticosteroids use for World Asthma Day (May 3), to help inform action to improve their experiences. The survey is available at www.asthma.org.au.

Asthma Australia has as its purpose to help people breathe better so they can live freely. The organisation delivers evidence-based prevention and health strategies to more than 500,000 people each year. The support Asthma Australia provides helps not only those living with the condition, but literally changes the lives of those who care for them and stand ready to provide lifesaving support to their loved ones, often when least expected. 

Asthma WA provides FREE individualised education and support to Western Australians with asthma and chronic obstructive pulmonary disease (and their carers), to improve health and wellbeing and decrease preventable ED presentations, hospitalisations and deaths. We aim to reduce the health, social and economic impacts of asthma and COPD through better management of these conditions, keeping people well in the community. We also provide education and training in group settings for GPs, practice nurses, pharmacies, schools, sporting clubs, workplaces, child-care centres and prisons and advocate on behalf of our consumers to reduce complacency and stigma.