First of all, remember that the oral steroids served a critical purpose. They helped you recover from a severe asthma flare-up. Or they are helping you avoid having a severe asthma flare-up. The dangers of not taking them in such cases are much higher than the dangers of side effects.
Of course, if you can prevent or minimise the need for oral steroids by keeping your asthma under control, that is the best option. Make sure you are working with your doctor to manage your asthma well, so you can breathe freely.
If you are taking continuous or very frequent oral steroids and you feel like your doctor isn’t exploring other , even when you have asked them to, it might be time for a second opinion. Another doctor or specialist who knows more about asthma might be able to find a way to get you off oral steroids all together.
What checks should I have?
If you have reached or surpassed 1000mg (1 gram) of oral steroids in your life, there is a higher risk of certain long-term side effects. This risk is dose-dependent. That means, the more oral steroids you’ve had, the higher your risk. That’s why we want to help you do everything you can to reduce your risks. To talk to us directly, call 1800 ASTHMA (1800 278 462).
For most tests, you will need a doctor’s referral or request form. Talk to your doctor about which ones they suggest for you. Depending on your history of oral steroid use, they might suggest all of these, some, or none at this time.
| Checks you might have |
What does it check for? |
Where can I get it? |
| Blood pressure checks |
Risk of heart disease, stroke and kidney disease |
Doctor or local pharmacy |
| Blood sugar test or oral glucose tolerance test |
Diabetes risk |
Doctor or local pharmacy |
| Cholesterol blood test |
Risk of heart disease and stroke |
Doctor referral |
| Blood test for vitamin D & calcium |
To see if you need supplements |
Doctor referral |
| DEXA scan |
Bone density |
Doctor referral |
| Eye exam |
Cataracts
Glaucoma |
Optometrist
These checks are included in a standard eye test for glasses, which is bulk-billed in most places |
| Mental health screening (K10) |
To see if you need support for depression or anxiety |
Doctor or Beyond Blue if you would prefer to do it online |
| Home Medicines Review |
Interactions with other medicines. Useful if you take medicines for a few different conditions |
Doctor can refer you to a community pharmacist or geriatrician |
| In rare cases:
Screening for adrenal suppression |
Adrenal insufficiency |
Doctor may arrange tests of your blood, urine and saliva |
What can I do to lower my risk of side effects?
Doing daily weight-bearing exercise is one of the best ways to keep your bones strong as you get older. This type of exercise is done on your feet, so you bear your own weight which jolts bones rapidly and firmly. Some examples are jogging, skipping, basketball, netball, tennis, dancing, impact aerobics and stair walking.
If you are pregnant, have been previously inactive, or have any medical conditions, it is recommended that you seek medical advice before commencing vigorous physical activity.
Work with your doctor, physiotherapist or exercise physiologist to make an exercise plan that is reasonable for you. Especially if exercise triggers your asthma.
Read more
This type of exercise includes hand and ankle weights or gym equipment. As you get stronger you increase the amount of weight you use. Regular, moderate intensity workouts can improve your fitness and quality of life with asthma.
Once again, work with your doctor, physiotherapist or exercise physiologist to make an exercise plan that is reasonable for you.
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. By losing weight, you may be able to take less asthma medicine. This can be difficult if you are on oral steroids for a long time. It is important to try to lose weight in a healthy way, without crash dieting to protect your bone strength. Talk to your doctor for ways they can help.
your doctor to get your levels checked. If your tests reveal you are low, then taking supplements might help your bone health. Your doctor or pharmacist can suggest one that is suitable.
If you smoke, quitting is the best thing you can do for your asthma. By stopping smoking, you will improve your asthma and lung health. It might not happen straight away, but this will help you reduce how many oral steroids you might need in the future.
Get help to quit smoking here
If your tests show high blood pressure or cholesterol, eating a balanced, low-salt diet can help improve it. Healthy eating can also help your airway health. Ask your doctor for a referral to a dietician for help with this. Referral can be made as part of a Team Care Arrangement if you have one.
Read more about healthy eating and asthma
What should I do if I am on maintenance oral steroids for severe asthma?
It is rare that anyone needs to be on maintenance steroids for asthma alone these days, so there is a good chance you’ll be able to reduce or stop daily steroids if you see a respiratory specialist.
If your asthma is bad enough to need maintenance steroids and you have not yet seen a respiratory physician, ask your doctor for an urgent referral. Best practice care for people with severe asthma is to be referred to a specialist.
Find out more about seeing a specialist here.
Of course, if you are taking steroids for a condition other than asthma, you will need to talk to your doctor or specialist relevant to that condition. They will consider if oral steroids are still the best option for you when taking into account all the risks and benefits.
If you take oral steroids for more than two weeks, your adrenal glands may become sluggish. This means your body may not be able to respond normally to illness or injury. It can be life-threatening if you are in a serious accident or need surgery.
Tell any new doctors, your dentist and anyone treating you in an emergency if you are using oral steroids. You may need extra steroids to make up for any adrenal insufficiency.
Some people like to have a medical alert bracelet for this purpose. Ask your doctor if this is a good idea for you.
Oral steroids affect your immune system, so you are more at risk of infection caused by a live vaccine. This is called being 'immunocompromised.' Caution is needed around certain live vaccines.
Live vaccines include measles-mumps-rubella (MMR) vaccine, varicella (chickenpox) vaccine, herpes zoster vaccine, yellow fever vaccine, rotavirus vaccine, BCG vaccine, Japanese encephalitis vaccine (Imojev only) and oral typhoid vaccine.
In general for adults, the risk of immunocompromise is when you are taking more than 20mg of oral steroids per day, which is a flare-up dose rather than a maintenance dose. For children, the risk depends on their weight, oral steroid dose and how long they are taking it.
Talk to your doctor about the best time to get vaccinated.
Taking oral steroids every second day can help you avoid certain side effects such as adrenal suppression. However, some people find that this is not enough to control their asthma.
Talk to your doctor about trialling every other day dosing, but be careful. Your doctor will explain what to do if your asthma flares up again. This is not suitable for everyone.
, or immediately after, food. If you only take it once a day, this is usually at breakfast time. This might help minimise , and interference.
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.
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