Health Tips

Steroids are a group of well-known medicines; most people recognise them by their performance-enhancing properties in bodybuilders and athletes. While that’s true for a subtype of steroids known as anabolic steroids, another subtype called corticosteroids is very useful in many medical treatments. 

Corticosteroids:

Corticosteroids are also very versatile– you may find them in different forms such as tablets, creams, nose sprays and inhalers. 

Steroid inhalers: an asthma preventer

‘Steroid inhalers’, also known as inhaled corticosteroids, are a group of medicine commonly used by people with asthma and in some cases, chronic obstructive pulmonary disease (COPD). They’re sprays or powders people with asthma breathe in using a device called an inhaler.

ILLUSTRATION BY JAVIER TRIGO via The Pharmaceutical Journal

There are several types of inhalers in the treatment of asthma and some asthma patients got 2-3 of them. Among them, there is an inhaler that patients use when they experience an asthma attack, called reliever; another type of inhaler patient uses every day even when they feel well is called preventer/controller. Steroid inhalers fall into the second category – they help prevent flares of shortness of breath and wheezing by reducing inflammation in the lung, which is commonly seen in asthmatic patients. 

Image credit: United States-National Institute of Health: National Heart, Lung, Blood Institute, Public domain, via Wikimedia Commons

That’s why it is important for patients with asthma to follow the doctor’s instructions and use steroid inhalers every day even though they did not experience any difficulty in breathing. Steroid inhalers slow down the progression of asthma, and can reduce the number of times of future asthma attacks.

With that being said, if you’re using steroid inhalers for the first time, do expect a delay in seeing its effects, which usually takes a few weeks to be evident. Many asthmatic patients love to use a reliever because the effect is almost instantaneous, but it's crucial to remember that it’s actually a preventer/controller like the steroid inhalers that offers long-term benefits for asthma.

What are some common inhaled corticosteroids?

Examples of inhaled corticosteroids include fluticasone (E.g. Flixotide®), beclomethasone (E.g. Beclazone®) and budesonide (E.g. Pulmicort®, Giona®). 

Corticosteroid inhalers are sometimes combined with a medicine called a "long-acting bronchodilator" in the same inhaler. Long-acting bronchodilators help open the airways. Using a combination inhaler makes it easier to take both medicines together. Examples of combination inhalers include budesonide-formoterol (E.g. Symbicort®) and fluticasone-salmeterol (E.g. Seretide®). 

How to use a steroid inhaler?

There are two different types of corticosteroid inhalers:

• Metered dose inhalers (MDI) – Most metered dose inhalers spray medicine when you press down on the top of the canister.

Image credit: NIAID, CC BY 2.0 , via Wikimedia Commons

• Dry powder inhalers – These release medicine when you take a deep breath in from the inhaler. Different dry powder inhalers are available. Each comes with directions on how to use it.

Image credit: BrettMontgomery, CC BY-SA 4.0 , via Wikimedia Commons

Most people take 1 or 2 puffs from their inhaler in the morning and 1 or 2 puffs in the evening. Each type of inhaler is used in a different way. Your doctor, pharmacist or nurse will show you the correct way of using it. 

Side effects?

Steroid inhalers are generally safe and cause little to no side effects if you use them correctly. Some of the common side effects associated with steroid inhalers are:

• Fungal infection in the mouth – This is also known as oral thrush or oral candidiasis. If you have a fungal infection in the mouth, tongue or in the throat, you may see white patches in your mouth, and experience soreness when swallowing. To help prevent fungal infection in the mouth, you should gargle and rinse your mouth with water after every time you use your steroid inhaler. Remember to spit out the gargled water, do not swallow them. If you do get fungal infection in the mouth, consult a healthcare professional for treatment.

• A hoarse voice

• A sore throat or mouth

Some people who need high doses of inhaled corticosteroids for a long time can have other side effects. These can include increased appetite, bruising, infections, thinning or weakening of the bones, and slowed growth in children. Nevertheless, these are rarely seen in people using steroid inhalers, and the benefits offered by steroid inhalers far outweigh the side effects.

I’m an asthma patient, why can’t I just take the pill?

Many asthma patients find it difficult to use an inhaler. They may wonder why can’t they just take a steroid pill, instead of using a steroid inhaler?

Corticosteroid pills that you can ingest are lifesaving in many cases, but they do come with many side effects, such as weight gain, facial puffiness, cataract, increased in blood pressure, osteoporosis, stomach ulcer, higher blood sugar level, reduced immunity…..

That is why you should never take steroids without the advice from a healthcare professional. Whereas for those who really need steroids for long-term, such as asthmatic patients, drug makers managed to make steroids into inhalers. Such pharmaceutical innovation is amazing because by inhaling steroids, it stays largely in the lung and only a tiny amount may enter the bloodstream. As a result, the overall body is exposed to less steroids, which results in fewer side effects. With steroids largely confined in the lung, it also maximises the therapeutic effect for treating asthma.

Important takeaways

1. When experiencing an asthma attack or 15 minutes before carrying out strenuous exercise, use the reliever inhaler, not steroid inhaler. Steroid inhalers act too slowly and it does not relieve asthma attacks when it happens. An exception is the combination inhaler budesonide-formoterol, which is often used as a daily controller medicine, but is sometimes also used for quick relief of symptoms.

2. It's important to keep using your steroid inhaler every day as your prescription says, even if you feel well.

3. Gargle and rinse your mouth with water and spit it out or brush your teeth after you use your steroid inhaler.

4. If you do not know how to use an inhaler, or find it difficult to use it, speak to your healthcare provider. They can provide additional tools that may be helpful.

5. If you are pregnant or want to get pregnant, talk with your doctor. Steroid inhalers are usually considered safe to use during pregnancy and breastfeeding, but it's best to review this with your doctor first.

A word from Doc2Us

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References

1. UpToDate - Patient education: Inhaled corticosteroid medicines (The Basics)

2. UOFM Health - Inhaled corticosteroids for asthma

3. American Academy of Allergy, Asthma & Immunology - CORTICOSTEROIDS DEFINITION

Cover image credit: NIAID, CC BY 2.0 , via Wikimedia Commons

Written by

Ms Joyce Toh