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Inhaled steroidsThere are two main types of medicine for treating asthma - 'preventers' and 'relievers'. Both of them come as inhalers, also known as 'puffers'. Here we look at preventers - most commonly containing 'inhaled steroids'. These are taken to reduce the swelling (and so narrowing) of the small tubes inside the lungs (the airways). Next week's 'Medicine of the week' will cover the main type of reliever medicine - beta2 agonists. Inhaled corticosteroid drugs, or inhaled steroids as they are usually known, are used to prevent the symptoms of asthma. The most widely used inhaled steroid is beclometasone (e.g. Becotide).
What are they for?Inhaled steroids are taken to prevent the symptoms of asthma, such as chest tightness, coughing, wheezing and breathlessness. They are usually used by asthma sufferers who are already using a reliever inhaler more than once a day. They are not used to treat an acute asthma attack.  How do inhaled steroids work?In people with asthma, the airways inside the lungs are 'hypersensitive' and in many cases asthma is linked to an allergy to dust, pollen, animal hairs, etc. Inhaled steroids work by reducing this hypersensitivity to prevent inflammation and narrowing of the airways that leads to the symptoms of asthma. This, in turn, reduces the production of mucus in the lungs that, for people with asthma, adds to the difficulty of breathing. Side effectsSteroids taken orally can often cause quite serious Side effects because they have to travel in the bloodstream and can affect other parts of the body as well as the place they are needed. However, inhaled steroids are much less likely to cause Side effects because they are delivered directly to the lungs, with a much lower dose getting into the bloodstream. Nevertheless, inhaled steroids can cause a husky or hoarse voice, which should ease off with time, and a sore throat due to a fungal infection (caused because the steroid can interfere with the natural defences of the throat). This may be prevented if you gargle with water after inhalation, or use a spacer (see below) to help reduce the amount of the drug that lands in the throat. A fungal infection can be easily treated with an antifungal medicine (from your doctor). Sometimes, inhaled steroids can cause sneezing attacks immediately after inhalation, as well as crusting and drying of the inside of the nose. This can be avoided by spraying the steroid away from the nostrils. You can ask your doctor or pharmacist to show you how to do this. Other Side effects have also been reported. These include a slightly increased risk of glaucoma (a condition caused by increased pressure in the eye) and cataracts (clouding of the lens in the eye). Inhaled steroids at high doses are more likely to cause similar Side effects to oral steroids than normal-dose inhaled steroids, particularly if they are used for a long time. These include suppression of the adrenal glands (glands on the kidneys responsible for producing the body's own natural steroids). So, if you do need a high-dose inhaled steroid, then you will be given a 'steroid card' to carry with you at all times saying what you are taking. This is because any additional medical treatment you need may have to be adjusted to allow for the steroids. In times of stress or illness, you may also need to take extra steroids in the form of a short course of oral steroids to protect you from asthma attacks. Long-term use of high-dose inhaled steroids can also cause bone thinning and an increased risk of osteoporosis. Although they don't seem to slow down children's growth in the same way as oral steroids do, children taking inhaled steroids will still need to have their height monitored regularly. Use inhaled steroids with care if ...You should use inhaled steroids with care:
Interactions with other medicinesDo not take any other medicines or herbal remedies with an inhaled steroid, including those you have bought without a prescription, before talking to your doctor or pharmacist. However, inhaled steroids do not interact with as many other drugs as steroids taken orally. How to use inhaled steroidsInhaled steroids are taken via an inhaler. There are several different types of inhaler available, such as aerosol inhalers, dry powder inhalers and breath-controlled inhalers. A spacer device attached to the inhaler means you do not need to carefully co-ordinate 'firing' the inhaler and breathing in. This makes inhalers easier to use, particularly for children. Inhaled steroids must be used regularly to work properly and an effect can usually be seen after three to seven days of use. If an inhaled steroid causes coughing when it is used, it might help to first take a couple of puffs of a beta2 agonist, such as salbutamol. Some people don't respond adequately to standard-dose inhaled steroids and need a high-dose inhaler. Some inhalers contain both a steroid and a beta2 agonist. WARNING: you should not stop taking your inhaled steroids suddenly or without consulting your doctor. Common inhaled steroids
July 2001 Back to Medicines index.
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