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CORTICOSTEROID THERAPY IN RESPIRATORY DISORDERS

What are corticosteroids?

Corticosteroids are not the same as the steroids that athletes use to improve muscle bulk or performance. The corticosteroid drugs used medically are, in fact, similar to those occurring naturally in the body and produced by the adrenal glands. These natural hormones are essential to the body in fighting stress, injury and disease.

Corticosteroids (sometimes called "cortisone") are effective anti-inflammatory drugs often used to help control inflammation. For example, in the bowel (colitis), in the joints (arthritis), in the skin (dermatitis) and in the lungs.

Asthma is the main lung condition where corticosteroids are used but sometimes they can also be helpful when lungs are damaged by cigarette smoke as in chronic bronchitis and emphysema. Corticosteroids are useful in the treatment of other lung diseases such as sarcoidosis, alveolitis and chronic inflammatory conditions.

How are corticosteroids administered?

These drugs may be given by mouth (tablets), by injection or by the inhaled route using an inhaler or dry powder device. Inhaled corticosteroids such as Aldecin ^TM, Becotide^TM, Becloforte^TM, Pulmicort^TM and Flixotide^TM are preferred because they have fewer side-effects. Inhaled medication must reach the small air passages in the lungs to be effective and this requires the correct use of the inhaler. Your doctor will advise you on the correct method for use.

How do corticosteroids work?

One of the important actions of corticosteroid drugs is to reduce inflammation. Inflammation of the inner lining of the bronchial tubes in the lung is the major cause of asthma symptoms. The anti-inflammatory action of corticosteroids makes them a most effective anti-asthma treatment.

When should I take oral and when should I take inhaled corticosteroids?

Corticosteroids should be used by inhalation wherever possible. Sometimes you may need to take corticosteroids by mouth or by injection. This is only advised in acute attacks of asthma or where the control of your asthma is deteriorating. Oral or injectable corticosteroids are sometimes used in other respiratory conditions. Corticosteroids used in this way are usually given for a few days to a few weeks only. Your doctor will advise you on the most effective method in your case.

What are the side effects?

Side-effects of corticosteroids are uncommon unless you take them for a prolonged period or in very high doses. It is common in many respiratory diseases, such as asthma, for the doctor to prescribe corticosteroid drugs for only one to two weeks, although occasionally treatment is needed for longer periods. When they are used in this way, side-effects are not frequent. As with any other drugs, unexpected individual reactions can occur.

Inhaled corticosteroids (eg Aldecin^TM, Becotide^TM, Becloforte^TM, Pulmicort^TM and Flixotide^TM) are preferred to corticosteroids taken by mouth (eg prednisolone, dexamethasone) because the dose required is much less and is delivered directly to the lungs. In addition, there are few side effects associated with inhaled steroid use. The commonest of these are hoarseness of the voice and a sore throat. The sore throat may be due to the development of a fungal infection (thrush) or due to the propellant in the puffers. Mouth washing and gargling after each dose and the use of a spacer device, such as a Volumatic^TM or Nebuhaler^TM will help avoid these problems. Other side effects are extremely rare.

Oral corticosteroids have a bad reputation in the community largely because of the side-effects that they sometimes produce. These usually occur only when corticosteroids are taken orally over a long period of time. The most common of these include weight gain, increased susceptibility to infection, slow healing, easy bruising, fluid retention, growth retardation in children, hairiness, diabetes and thinning of the bones (osteoporosis) particularly in women during and following the menopause. Sometimes emotional upset such as depression can be troublesome. Corticosteroids may also cause indigestion and occasionally bleeding from the stomach. You should notify your doctor if you have ever suffered from peptic ulcers, indigestion or heart burn in the past.

Please Note: This information is intended by The Australian Lung Foundation to be used as a guide only and is not an authoritative statement. Please consult your family doctor or specialist respiratory physician if you have further questions relating to the information provided here.