Oral corticosteroids – sometimes just called ‘steroids’ or ‘pred’ have been an important part of asthma management for more than 60 years. They can be crucial in severe flare-ups and attacks to get asthma under control quickly.  

Like most medicines, they can cause side effects. Because oral steroids are absorbed into the bloodstream, not just to your lungs, the side effects can happen in lots of places around your body.OCS GIF with arrows

On the other hand, inhaled steroids, such as a preventer inhaler, travel straight to your lungs. Sometimes, they may cause minor side effects around the mouth and throat, but this is uncommon. 

Oral steroids should only be used when really needed. To reduce your need for them, make sure you know how to recognise a flare–up early, use an Asthma Action Plan to respond and follow our tips for good asthma care. 

Risk vs Benefits
While we want to help you avoid the need for oral steroids, if you do have a flare-up you may still need them to get your asthma back under control.

Asthma can be life-threatening and oral steroids can help keep you alive.

Your doctor will carefully consider these risks and benefits when making treatment decisions.

If you are currently taking oral steroids, please discuss any concerns with your healthcare provider before stopping the medicine.

What are the side effects of Oral Steroids?

Even a short course of oral steroids can cause short-term side effects and contribute to your risk of developing long-term side effects in the future. 

Some of these short-term side effects include things like mood swings, upset stomach, hunger, weight gain and trouble sleeping. These side effects are usually mild and go away once you stop taking the medication. 

But what about the long-term risks of oral steroids?

When oral steroids are needed for long periods of time or in high doses the risk of side effects gets larger. 

People who have needed over 1000mg of oral corticosteroids in total over their life time, are at much higher risk of severe side effects. This amount is equal to about four standard adult five-day courses that might be prescribed for an asthma flare up or attack. Some of these serious side effects might surprise you. For example:  

  • Osteoporosis and fractures 
  • Hypertension 
  • Obesity 
  • Type 2 diabetes 
  • Gastrointestinal ulcers or bleeds  
  • Cataracts and glaucoma 

Show me the maths

The research found that the greatest risk of severe long-term side effects is found in people who have reached a toxic threshold dose of 1000mg in their lifetime.

A typical steroid course for adults might be 50mg a day for 5 days. Like this:

1 dose of OCS 50mg/day x 5 days = 250mg

So, that’s 250mg for 1 course. If you only ever needed 4 courses in your entire life, that would add up to:

OCS Toxic dose 2

250mg/course x 4 courses = 1000mg 

See? That’s 1000mg, but that’s spread out over multiple courses, probably with breaks in between. So, while you might have already said goodbye to short term side-effects, your risk for long-term side effects has already gone up.

If you are concerned that you have already passed the potentially toxic threshold of 1000mg in your life – you are not alone! Research suggests that up to a quarter of people with asthma will use a harmful dose in their lifetime. Talk to your doctor or call us on 1800 ASTHMA to learn what to do next.

So, what can I do about it?

The number one thing you can do about it is take action to make any flare-up your LAST.  

The good news is that about 9 out of 10 flare-ups are preventable with treatments that are already available. You can reduce your risk of needing oral steroids by keeping your asthma under control with good asthma management. The best way to do this is with a much less risky dose of inhaled steroids in a preventer or dual-purpose reliever.  

Some people think that daily steroids must be worse for them than taking oral steroids for a few days, but this is not the case. The way the steroids spread through your body makes a low dose of inhaled steroids the best option to keep your asthma under control and avoid long term side effects.  

If your symptoms are not settling quickly, let your doctor know. There might be other health issues adding to your symptoms beyond asthma, so ask to be assessed by a specialist. Don’t just ‘wait and see’ and end up needing more oral steroids! 

Access Better Asthma Care

Check that you have all the basics of asthma care covered. 

Asthma Basics

If you have severe asthma, you might be very familiar with the side effects of oral steroids. Click below for more information about severe asthma.

Severe Asthma

 

Key reference: Blakey et al. (2021). Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand. Respirology, 26(12), 1112-1130. doi:10.1111/resp.14147

Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291960/

The Oral Corticosteroid Stewardship Project is a leading partnership between Asthma Australia and the Centre of Excellence in Treatable Traits together with the Thoracic Society of Australia and New Zealand to improve care and outcomes for people with asthma. 

Materials for the Oral Corticosteroid Stewardship Project are developed independently, made possible by grant funding from Chiesi Australia, Sanofi, and GSK, who are not involved in their development.