Oral steroids for asthma: “The Devil’s Tic-Tacs”

Everyone has heard of steroids and the majority of people will think there is only one type of steroid. The ‘bad steroid’ is the anabolic one that the bodybuilders abuse and that you hear about when athletes have failed drug tests. But these steroids are not the steroids which most people with asthma will depend on.

Unless you are newly diagnosed and on the first step of asthma ladder, where you would only require a short-acting bronchodilator (SABA), then every asthmatic will be on some sort of corticosteroid. It will most likely be an inhaled. The inhaled corticosteroid (ICS) is inhaled into the lung and will act locally in your airways rather than effect you systemically. This is why inhaled therapy for asthma works so well because you can get the medication to work directly where you want it.

However, there is the odd occasion when you are climbing the steps on the asthma management guide and have the SABA, ICS at varying doses, long-acting beta agonist (LABA), leukotriene antagonist(LRA), theophylline, nebulisers, antibiotics, antihistamines and you are still not getting any control. Your consultant may then be forced into using long-term oral steroids.

A short burst is great. A chest infection or asthma exacerbation 40mg of prednisilone is no bother and really won’t cause you much harm. It will do more good than harm. Your breathing will feel better and 5 days later you’re off them feeling great. But what happens when a short course turns into lots of short courses which turns into permanent long-term steroids and then you find you have a maintenance dose and finding the lowest dose you can get to which can then become your maintenance.

You may have gathered already that I am not a fan of steroids.

Others who have severe asthma or uncontrolled asthma will have lots of different names for steroids. The medication name for the oral steroid used most commonly in asthma in the UK is prednisolone, however, it has a lot of nicknames and nicknames surrounding some of its side effects.

Nicknames for prednisolone included:

• Dreaded pred.
• Devils tic-tacs.
• Asthma’s happy pills.
• Pred.

The main reasons prednisolone gets such a bad reputation when you have to take it long term is that as great as it is at helping you to breathe it is a killer on the rest of your body. The fact you can breathe better is worth the extensive list of side effects which have also earned themselves some great little nicknames like:

• Predsomnia: insomnia induced from being on long-term prednisolone.
• Predmunchies: the extreme hunger associated with long-term prednisolone and the craving for carbohydrate or chocolate. Fruit and veg just won’t satisfy the predmunchies.
• Moon face: the stereotypical shape your face goes when you are on long-term steroids. How does everyone face end up the same shape pre-pred you could all have totally different face shapes but predface you all look the same.

Over the years I have had a huge love-hate relationship with prednisolone and prednisolone was responsible for my somewhat dubious medication compliance when I was younger. I did stand up and talk about this in a room full of Asthma UK employees. Among the group were some early pioneers in asthma management. It was a little nerve-wracking confessing my poor compliance. As I told the room I saw why prednisolone is needed to treat asthma and get on top of it but what happens when you have constant bad spells. It makes you better and almost lulls you into a false sense of security because rightly the Drs don’t want you on it long term but when they take you off it you’re back to square one. What’s the point in taking it in the first place to feel better for the time your on it for it to be taken away and you feel awful again? So, I really didn’t see the point of taking it at all.

I then got a new consultant who actually treated me as a person and understood me and my feeling towards steroids etc. We achieved a good balance and the compliance was no longer an issue (to note the dubious compliance was only with the prednisolone I always took my inhalers, anti-histamines and other meds).

I still feel conflicted taking prednisilone even now. My consultant and I disagree somewhat on it but I am of the opinion my work is important to me and I am all too aware I won’t be working for long unless there is a miracle so if pred means I can work then pred wins. It won’t be forever but doing FeNo testing, which measures inflammation in my lungs, I can see the good effect it has.

But with all the good and the easy breathing with it there is the fear that I think all consultants, asthma nurse specialists will have. For all the good pred does there are some devastating side effects which go with it. For me long term prednisolone has caused:

• Osteopenia.
• Adrenal insufficiency.
• Immunosuppression.
• Optic nerve neuritis.
• Amenorrhoea.
• Thin skin.
• Altered healing.
• Reflux, myopathy.
• Fluid retention.
• Mild depression.
• Insomnia.

The list is fairly large and requires medication to counteract some of the side-effects but I guess being able to take medication for the side effects of the prednisolone beats not taking the prednisolone and not being here.