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| Oral corticosteroids: something many people living with asthma know simply as ‘steroids’ or ‘pred.’
As you read these pages, keep in mind that oral steroids are still an important rescue medicine that saves lives for people with asthma, when prescribed and used for the right reason. However, we need to be more cautious with their use, as we are now more aware than ever of the long-term consequences and side-effects of oral steroid use. |
Oral steroids have been an important part of asthma management for more than 60 years. They can be necessary to quickly bring asthma under control during severe flare-ups and attacks.
Like most medicines, oral steroids can cause side effects. Because oral steroids are absorbed into the bloodstream, their side effects may be felt around your whole body. Whereas inhaled steroids in preventer inhalers travel straight to your lungs. Sometimes, they may cause minor side effects around the mouth and throat, but these are considered minor, and uncommon.
Due to the higher likelihood of side effects, oral steroids should only be used when really needed. That’s why we’re helping people with asthma and their health professionals to be smarter in using oral steroids for asthma care.
What are oral steroids?
Oral steroids are a strong anti-inflammatory medicine. For people with asthma, they quickly reduce swelling in your lungs during a severe flare-up, helping you breathe more easily.
Oral steroids are taken by mouth and are absorbed into your blood to be transported to your lungs, where they are needed. But because they travel in your bloodstream, they also reach other parts of your body, which can result in unpleasant, and sometimes very serious side effects. This is why oral steroids should be prescribed, and used, with care.
In contrast, inhaled corticosteroids – found in preventers – are breathed into the lungs and are delivered directly to where they are needed. Want to learn more about how oral steroids work? Check out our medicines guide here: https://asthma.org.au/medicines/oral-corticosteroids/
Avoiding flare-ups
The best way to avoid needing oral steroids for asthma is to manage your asthma so well that flare-ups become rare, or are avoided completely.
There is very strong research that tells us the best way to reduce the number of asthma attacks you have, is to use a low-dose inhaled corticosteroid (found in most preventers) as part of your asthma routine. Which option is right for you depends on your unique circumstances.
Nobody’s asthma is the same.
The side effects of oral steroids
People who have taken over 1000mg of oral corticosteroids in total over their lifetime, are at much higher risk of severe side effects. This may be as little as 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.
Learn more about the risks and benefits of oral steroids here: https://asthma.org.au/oral-steroids-for-asthma-risks-and-benefits/
Over the toxic threshold?
Many people have passed the threshold of lifetime use of oral steroids that is likely to lead to side effects. The possible long-term side effects are varied and dose-dependent.
The more oral steroids you have had, the more likely you are to experience some side effects.
You may have had enough oral steroids already in your life that you are expecting or already experiencing some side effects. But there may still be things you can do to reduce their severity or mitigate them somewhat.
Learn more here: https://asthma.org.au/passed-the-toxic-threshold-of-oral-steroids/
Severe asthma
People with severe asthma are much more likely to have side effects from oral steroids, because their lifetime use is usually much higher than someone with very few asthma attacks.
However, this may soon start to change, as the requirement for oral steroid use has been removed from the Pharmaceutical Benefits Scheme criteria for biologic medicines (sometimes called monoclonal antibodies). This means people with severe asthma can access life-changing, targeted treatment sooner.
Learn more about severe asthma and specialised treatments here: https://asthma.org.au/about-asthma/severe-asthma/
Better asthma care
Whether you have severe asthma, or you just aren’t happy with the care from your current doctor, many people will benefit greatly from exploring further options for their asthma care.
We have in-depth information about the different levels of asthma healthcare here: https://asthma.org.au/how-to-access-better-asthma-care/
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Information and materials developed for Oral Corticosteroid Stewardship are developed independently by Asthma Australia, with support from the Centre of Excellence in Treatable Traits. In 2024, this work was made possible by unrestricted grant funding received from Chiesi Australia, GSK and Sanofi.
