Systemic corticosteroids for quick relief during asthma attacks
The following medicines can be given as an injection:
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The following medicines can be given as pills or liquid:
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How It Works
Systemic corticosteroids travel throughout the body before reaching the airway. This results in more side effects and more serious side effects than with inhaled corticosteroids, which treat inflammation in the airways only.
Why It Is Used
Systemic corticosteroids help control narrowing and inflammation in the airways of the lungs in asthma. They are used to:
- Get relief of asthma symptoms during a moderate or severe asthma attack.
- Get control of symptoms when you start long-term treatment of asthma after your initial diagnosis.
Corticosteroids may make the episode shorter and prevent early recurrence of episodes. The length of treatment with corticosteroids can be different depending on the person. It your attack wasn't very severe, you could take corticosteroids for only 3 days. But you may need to take them for as long as several weeks for a very severe attack.
People with severe persistent asthma may need to take corticosteroid pills or liquid by mouth daily or every other day to control their symptoms.
Different types of medicines are often used together in the treatment of asthma. Medicine treatment for asthma depends on a person’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.
- Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
- The least amount of medicine that controls the asthma symptoms is used.
- The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
- If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
- Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.
Your doctor will work with you to help find the number and dose of medicines that work best.
How Well It Works
Side effects of long-term treatment with steroids given by mouth (pills and liquid) include:
- Slower growth or stunted growth in children.
- Problems with the body's ability to use glucose (diabetes).
- Bone weakening (osteoporosis) or possibly bone death (aseptic necrosis of the femur) from changes in blood supply.
- High blood pressure (hypertension).
- Repeated infections, bruising, and skin thinning (atrophy). Corticosteroids also make it less likely you will have a fever, so that an infection is not always recognized immediately.
- Clouding of the lens of the eye (cataract).
To minimize or prevent side effects of corticosteroids:
- Keep the dose of corticosteroids as low as possible while still maintaining asthma control.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Steroids by mouth or injection may be given as short-term treatment after an episode or when asthma has not been under control. “Burst” treatment with steroids may be continued for 3 to 14 days or longer. A person who has frequent asthma episodes while being treated with inhaled steroids may need to have the medicine increased.
In children, steroid pills reduce the severity and length of an asthma attack. But for the pills to stop an asthma attack, it is important to give them at the first sign of symptoms.3
Pregnant women who use steroids by mouth or injection may have babies with low birth weights. If you are pregnant, may become pregnant, or are breast-feeding, talk to your doctor before using these medicines.
Women who use steroids by mouth or injection for long periods of time and who have gone through menopause need to take extra calcium and vitamin D, and possibly bisphosphonates (such as Fosamax), to prevent bone loss (osteoporosis).
If you have been using systemic steroids for more than 3 weeks and are going to stop taking them, you need to gradually decrease the amount you use, rather than stopping them all at once. This will help avoid problems with the adrenal glands.
- Dennis RJ, et al. (2007). Asthma in adults, search date October 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Keeley D, McKean M (2006). Asthma and other wheezing disorders in children, search date October 2005. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Rachelefsky G (2003). Treating exacerbations of asthma in children: The role of systemic corticosteroids. Pediatrics, 112(2): 382–397.
Last Updated: April 21, 2009