Corticosteroids are man-made hormones and are commonly called as exogenous steroids. They are similar to cortisol hormones (glucocorticoids) made by the adrenal glands in the human body. Corticosteroids medications are present in different forms as tablets, inhalers, topical lotions and injections. They act as anti-inflammatory drugs and suppress the immune system. They are used in controlling or treatment of medical conditions such as eczema, asthma, rhinitis, inflamed bowel diseases and multiple sclerosis. These steroids are different from the anabolic steroids taken by the athletes.
Inhaled steroids are present in three forms as: the metered dose inhaler (MDI), dry powder inhaler (DPI) and nebulizer solutions. Few of these include Beclomethasone Dipropionate, Budesonide, Fluticasone and Mometasone.
Overall benefits of inhaled corticosteroids are more than the risks and side effects associated with taking them such as:
- Improved the lung function.
- Reduced asthma attacks.
- No immediate emergency hospitalization is required.
- They do not cause degeneration of the normal tissues of the respiratory passage.
- They do not predispose to lung infections.
- They do not cause cancer, diabetes or high blood pressure.
Although, inhaled corticosteroids have enormous benefits, there are also side effects of inhaled corticosteroids.
Overview of the Side Effects of Inhaled Corticosteroid
Generally, doctors prescribe inhaled steroids since they have targeted effects. Doctors advise intake of steroids as medicine to reduce or clear the inflammation of the airways in case of asthma. However, inhaled steroids are slow acting and take hours to show the effects. Patients with asthma are required to use inhaled corticosteroids regularly. Improvements are seen within 3 weeks and best results are observed after 3 months.
The doses of inhaled corticosteroids vary. High dose of Inhaled corticosteroids (ICSs) is defined as >1000 mcg beclomethasone dipropionate (BPD) equivalent per day. For majority of the patients, low doses with short term use do not lead to side effects or health problems. While high doses of inhaled corticosteroids are prescribed for patients with severe persistent asthma. This is done since these patients do not respond well when medium dose of inhaled corticosteroids is administered along with beta2-agonists. Although, use of corticosteroids shows more benefits than the associated risks, long duration of high dose of steroids usage may show side effects.
Side Effects of Inhaled Corticosteroids
Local Side Effects of Inhaled Corticosteroids:
The local side effects due to inhaled corticosteroids are:
- Hoarseness and husky voice.
- Oral candidiasis (thrush).
Severe Side Effects of Inhaled Corticosteroids:
Prolonged use of high dose inhaled corticosteroids causes side effects like:
- Impaired growth in children.
- Decreased Bone Density and Osteoporosis. Glucocorticoids reduce bone formation and increase bone resorption by direct action on osteoblasts and osteoclasts. This can lead to loss of calcium via urine and decreased calcium absorption through vitamin D. Loss of calcium from bone leads to weakening of bones.
- Systemic side effects of inhaled corticosteroids also affect the gut, thereby reducing the total storage of calcium in the body.
- Skin thinning and bruising.
- Eye disorders such as Cataracts and Glaucoma.
Treatment with high-dose Inhaled Corticosteroids can result in clinically significant suppression of endogenous cortisol hormone.
How is the Extent of Side Effects of Inhaled Corticosteroids Diagnosed?
The doctor performs physical examination and records medical history. The following tests are advised to know the extent side effects of inhaled corticosteroids:
- Growth is determined using kinemometry to measure the changes in lower leg length as a measure of short term growth over period of 2 to 4 week period. A decrease in short term leg growth indicates the systemic activity of inhaled corticosteroids.
- Measurement of bone mineral density.
- Urinary or blood cortisol levels are checked for patients with symptoms of skin bruising.
- Checking of the eyes of adults for presence of cataract and/or glaucoma.
How are the Side Effects of Inhaled Corticosteroids Treated?
The main strategy of the treatment for side effects of inhaled corticosteroid is to decrease the risk associated with inhaled corticosteroids by optimizing the dose. It is recommended that dose of any inhaled corticosteroids should be decreased by 25 to 50% in patients with good asthma control. However, one should not completely stop the daily habit of inhaling steroids. The patient should be taught to optimize the inhaler technique or should use a metered dose inhaler with a spacer device. Both these techniques can improve the steroid deposition in the lung.
To minimize the side effects of inhaled corticosteroids the following suggestions are to be followed:
- When people face mild side effects due to inhaled corticosteroids, they can protect against these side effects by cleaning mouth with water, gargling with lukewarm water to remove the leftover medicine present in the mouth.
- The dose should be decreased gradually.
- One should monitor the blood pressure and treat it if necessary.
- One should monitor the bone density and follow medications to help maintain bone health.
Inhaled corticosteroids are the most effective long-term controller of asthma. The recommended low doses of steroids are cornerstone of asthma treatment. Though very less, inhaled corticosteroids have minimal side effects. However, not taking the inhaled corticosteroids can have worse effects such as asthma attacks. Although, asthma can be treated with steroid tablets as well; however, they can give rise to even more health worsening side effects. Inhaled corticosteroids are often considered safe for children and adults in low doses and hence one must follow the doctor’s advice to avoid any worst health conditions. The milder side effects can easily be prevented by following the preventive measure like gargling post the usage of inhaled corticosteroids.
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