What are the long-term effects of steroids for uncontrolled asthma?

Question

Hello doctor,

I have had uncontrolled asthma for years, especially when I was living abroad. Now that I am back and my treatment is on track, my symptoms are improving. But I cannot help feeling a bit worried about all the steroids I have been taking over the years. I know they are helping with my asthma, but will these doses cause other health problems down the line?

I am 50 now, and I want to make sure I am not trading one issue for another. Should I be concerned about long-term side effects or start thinking about alternative treatments?

I have heard steroids can impact bones, weight, and other things, and it is making me anxious.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you already described, you are suffering from bronchial asthma. Key to the treatment of asthma is the use of inhaled medications. For adequate asthma control, appropriate inhalers in the right dose are to be used with adequate technique, and they should be used regularly.

Regarding side effects of steroids:

Side effects are almost always with oral steroids (anti-inflammatory drugs) and rarely occur with inhaled steroids.

Hence it is very important to control your asthma symptoms so that oral steroids are not required at all in the future and hence you will be almost free from the side effects of steroids.

To prevent repeated exacerbations in the future, you should be aware of the following:

Causes for repeated exacerbations include:

1. Presence of comorbid conditions like allergic rhinitis, GERD (gastroesophageal reflux disease), and obesity.

2. Incorrect inhaler technique or if the inhaler is not being used regularly.

3. If incorrect inhaled medicines are being used.

4. Fungal sensitization and hypersensitivity.

5. Emotional stress.

6. Environmental factors, including pollution and pollen.

The following advice is to be followed if bronchial asthma is diagnosed:

1. Start regularly using an MDI (metered dose inhaler), Budetrol (corticosteroid) (200/6) inhaler, two puffs twice daily with a spacer followed by mouthwash, and stop using a Salbutamol (short-acting beta-2 adrenergic agonist) inhaler. Inhalers are to be used daily without any break for at least six months. No dose is to be skipped unless advised by a pulmonologist.

2. Mac spacer (it is to be attached to an inhaler; the technique of its usage can be learned online).

3. Consult a pulmonologist either physically or virtually regularly (at least once monthly).

4. Take vaccinations appropriate for the age if not taken already.

5. Control of co-morbid conditions, if any.

6. Inculcate regular exercise and physical activity into your routine.

7. Ensure intake of a balanced and nutritious diet.

Asthma can be very well controlled with adequate treatment and appropriate guidance and hence will not require oral steroids. Get the investigation advised and follow up after one week.

Kindly consult a physician, discuss with them, and start taking the medications with their consent.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.