Systemic Corticosteroids for 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 by mouth or injection may be used as short-term treatment after an asthma attack or when asthma has not been under control. "Burst" treatment with corticosteroids may be continued for 3 to 14 days or longer. A person who continues to have asthma attacks while being treated with inhaled corticosteroids may need to have the dose of medicine increased.
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 who have 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.
Your doctor will work with you to help find the number and dose of medicines that work best.
How Well It Works
A review of research shows that treatment with systemic corticosteroids during an asthma attack reduced hospital admissions and the frequency of relapse in adults.1
A review of research on treatments for asthma in children found that systemic corticosteroids during an asthma attack shortened the duration of hospital visits for asthma attacks for children.2
In children, corticosteroid 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
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Common side effects of long-term treatment with corticosteroids given by mouth 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
If you have been using systemic corticosteroids 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.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Women who have gone through menopause and who use corticosteroids by mouth or injection for long periods of time need to take extra calcium and vitamin D—and possibly bisphosphonates (such as Fosamax)—to prevent bone loss (osteoporosis).
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Rodrigo G (2011). Asthma in adults (acute), search date April 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Okpapi A, et al. (2012). Asthma and other recurrent wheezing disorders in children (acute), search date June 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Rachelefsky G (2003). Treating exacerbations of asthma in children: The role of systemic corticosteroids. Pediatrics, 112(2): 382–397.
Last Revised: February 22, 2013
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