Are Long Term Inhaled Steroids Safe?

Many patients are prescribed inhaled corticosteroids for asthma control. With good reason, patients are concerned about the long term effects of taking these medicines. In this entry I will review some information on the risks and benefits of taking inhaled steroids for asthma.

Adults

Inhaled steroids are an important part of a treatment plan for the majority of patients with asthma. They reduce the inflammation in the airways (breathing tubes) that narrow them and cause wheezing. They also reduce abnormal growth of the smooth muscles around the airways, which, when they tighten, also cause wheezing. Most importantly, when taken properly, the medicine is delivered ‘where it needs to be’. i.e. in the lungs, and not elsewhere. Due to the benefits of inhaled steroids, they are taken by many patients, whose asthma is much better controlled as a result.

Nevertheless, there are side effects, which can occur in some individuals who are taking very high doses due to more severe asthma. These side effects are no different than for patients who take steroid pills (“prednisone” is a very common one). These include abnormalities of the bones, eyes, and immune system. In addition, our natural production of steroid hormones is changed when we take steroid-containing medications.

For doctors taking care of asthma patients, prescribing inhaled steroids is always a balance between benefits and side effects. In low and medium doses, the scales are usually tipped toward prescribing them - the side effect risk is quite low and potential benefit great. For individuals with more severe asthma requiring high-dose inhaled steroids, each case is taken individually. Certain steps, including dietary changes, can also be taken to minimize adverse effects. If you are concerned about side effects from long term inhaled steroids, you should ask your doctor if you are taking high doses and what steps you can to minimize long term side effects.

Children

Since children’s bones and other organ systems are actively developing, doctors are very careful about prescribing inhaled steroids to kids, despite their well-proven efficacy. It has been shown in clinical studies that children taking inhaled steroids have changes in their growth, specifically their growth velocity. This means that, on average (each child is different), children taking inhaled steroids will grow slower than their counterparts, but will eventually reach the height they would have had they not been taking steroids. Beyond that, the decision is very similar to that made in prescribing inhaled steroids to adults.

In general, for both children and adults, the goal of asthma treatment is to obtain the best control with minimal side effects, both short and long term. My personal philosophy is to do what I can for patients to breathe better, understanding the possibility of side effects developing, which I monitor. Life without breathlessness, particularly for children, is a worthwhile goal even in the face of potential limited risk.