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Are oral steroids a good substitute for preventer inhalers ?

ihatesteroids
ihatesteroids

After getting asthma two years ago,I tried some preventer inhalers.However,some worsened my breathing problems,while others used to totally block my nose.That made it impossible to breathe through the nose,or to sleep.

Finally,I started using oral steroids.Been taking 40 mgs. for several months now,and there is an improvement in my asthma.I've even stayed asthma free for a few months,and my nose never gets blocked.

My doctor says that I should continue to take oral steroids for several years.So far,the side effect I've experienced is weight gain.I presume 40 mg. is a low dose,with lesser chance of significant side effects.Are oral steroids a good substitute for preventer inhalers ?

What do you think ? Thanks.

24 Replies
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The short answer is no, they're definitely not. Oral steroids, especially at high doses and especially for long periods of time, have all sorts of harmful side effects. Some asthmatics are controlled on their usual preventer medication but can't help but have to take regular courses of oral steroids for flare ups. Others need daily oral steroids at low or high dose on top of their preventer medication. Of course this is not ideal given the side effects but, in these cases, it's about weighing up those against the need for them for their asthma and when there is no other option.

There are other preventer treatments available which should really be tried before a doctor just decides literally nothing works. Also there may be things you can do to combat the blocked nose effects for example.

Is this your GP? Are you under a respiratory consultant? Are you in the UK? Sorry for all the questions - I'm so surprised a doctor would actually say this!

Thanks.I'm not in the UK,and my doctor is not a consultant.However,my asthma was severe enough not to be controlled by anything else.This is the only medicine that has made me feel better.For a year,I avoided oral steroids fearing the worst and had no relief from asthma.It was then that my doctor prescribed their long term use with extreme reluctance.

I also came across an article on the asthma UK site about their long term use a patient who has been using oral steroids for eleven years.Doubtless,the potential list of side effects is scary,but seems I have little choice.I spent innumerable sleepless nights with a severely blocked nose.I couldn't eat a lot of things due to severe coughing fits.Not milk,not fruit,not anything even slightly cold.Now,I don't have these issues.When I used ventolin,I got a blocked nose, too.Now that is not the case.

My asthma seems too severe for other medication to work.

Agree with the previous comment. Steroids do work quickly and very effectively on asthma. 40mg would only usually be prescribed when you are really struggling and then only for a week. Usually you would them wean down to a much lower maintenance dose if you need to have them daily.

My daughters consultant is constantly trying different things to get her off steroids as there are so many side effects to them. If you need such a high dose I would expect you to be under a consultant who would look at alternatives.

My daughter is currently on the waiting list for an injection which they hope will get her off the steroids.

Yes,I tried short courses for a couple of weeks,but then the symptoms returned.

No they are not... they are the reason I got deemed 'too risky' for life insurance (despite all the other crap I take) they where particularly interested in the tablet/oral steroids and they told my financial advisor specifically that they would not insure me because of the number of short courses I had had over the last three years

The long term side effects of long term oral steroids / frequent short courses are terrible and can be irreversible things like: adrenal insufficiency, steroid induced diabetes and bone thinning/wastage .... you will be much better on a preventer that works for you as they are much much lower dosages and in theory (I know this isn't true for me) they shouldn't leak into your blood stream in any real numbers

Chip

I suppose that preventer inhalers can cause significant long term damage too,if the asthma is severe enough,as then they have to be taken in very high doses.But they have only aggravated my symptoms without providing relief.

Haven't had life insurance yet,too bad if the risk is deemed so great.

yes but tablet steroids are measured in mg (milligrams) and inhaled steroids are measured in mcg (micrograms) so you would need an awful lot (infact I think you would go dizzy and pass out from trying to inhale that much) of inhaled steroid to equal the dose of tablet steroid you are on

As others have said, long term oral steroids can have long term side effects. Can you request a referral to an asthma specialist so that you can be thoroughly screened for the type of asthma and allergies?

Picking up on your side effects from the prescribed inhalers, were you taking aerosol inhalers or dry powder? And have you been screened for aspirin allergy? It's important to rule this allergy out in order to establish tolerance to aerosol inhalers. A stuffy nose (nasal polyps) can be an indicator of aspirin allergy and the need to prescribe dry powder inhalers. Between 8% & 20% of asthmatics cannot tolerate aerosol inhalers which can exacerbate asthma symptoms.

A specialist will be able to consider more targeted treatment based on your type of asthma and its severity. There are a range of medications that can be tried before resorting to long term oral steroids.

ihatesteroids
ihatesteroids in reply to Poobah

Yes,I haven't tried powder inhalers so far,will try them.Thanks.

Poobah
Poobah in reply to ihatesteroids

I think you need to have a proper evaluation with a specialist in order to get a clear picture of what is going on. If you do have any intolerance or allergy then you may be able to address some of your symptoms and have a less severe form of treatment as a result. Just trying medication after medication is a scatter gun approach if you're not being properly monitored by a specialist. By all means try dry powder inhalers but also ask for a referral to see a specialist.

stones93
stones93 in reply to Poobah

Absolutely agree with you on this one. Definitely need a specialist not a GP if you arein this predicament.

Bdo you take 40 mg of steroids a day or week iam on 5 mg a day just started new inhaler been on it a week it's called trimlow any one else on this

You're lucky to be on 5 mg a day.I've been on 40 mg a day.

I've had 2 courses of 8 5mg a day for 5 days took twice in 2 months only 5ml a day don't know if it does any good dr said I had to stay on 5 mls for a few months so don't know when I will stop them asthma not been under control for months constantly ringing gp said he is looking into what will help stay safe Christine

It does sound like your asthma is poorly controlled without steroids which I understand so definitely continuing to work with doctors to experiment with adding more meds seems like the best plan. Has your doctor talked to you about biologics? I am on Xolair and that has helped me quite a bit-

As someone who developed adrenal insufficiency from prednisone use I can say emphatically that they are not a good alternative to inhaled steroids which have a significantly lower dose of steroids.

I now have developed a health problem (adrenal insufficiency) with a whole host of other issues that is just as troublesome and dangerous as asthma, if not more so. My cortisol is constantly off and I will have to take hydrocortisone daily throughout the day for the rest of my life just to try to feel normal.

No doctor ever mentioned this was a possibility from taking too many courses of prednisone for my attacks so I'm just sharing my experience.

Biologics are too expensive,so I haven't tried them.The inhaled steroids I've tried made my condition so much worse.I didn't take oral steroids for a whole year after getting asthma,as I had read too many bad things about them.If the disease becomes bad enough,desperate measures are called for.And adrenal insufficiency is inevitable,I suppose considering the severity of my condition.But the remarkable thing is that I remained asthma free for nearly three months this summer.That had never happened before in the two years since I developed asthma.

Thanks everybody.I guess It's time for me to get a second opinion and re evaluate the present treatement.

Weee you diagnosed initially at a specialist breathing clinic or by your doctor? I was just wondering if it’s definitely asthma?

Oh,it's definitely asthma.I've nearly died of it on some occasions and have needed steroid injections to save my life.As bad as Steroids can be, I won't be alive today if it weren't for oral steroids and steroid injections.

There’s something called vocal cord dysfunction that can look like asthma and people get misdiagnosed. Inhalers don’t work with VCD. That’s why I asked.

No,my vocal cords are fine.

That’s good.

Frazzle
Frazzle in reply to Itswonderful

Just hopping onto this to say it’s definitely worth getting an ENT referral as well as an asthma specialist to look at other medications and treatments you can try. if you haven’t had VCD ruled out, it would be worthwhile to do that, as it can be incredibly similar and requires a scope in order to rule in or out if that makes sense.

Your current regime sounds dangerous but you should never come off steroids without doctors supervision. Steroids can mess up the body’s HPA axis and stop the body producing its own cortisol. In other words, the body senses that there is already lots of steroid there so it stops making it. This can cause adrenal problems.

My experience is from using steroid creams over a period of 15 years. Creams are nowhere near as strong as oral steroids but I went through a horrendous withdrawal stage where it became clear to me the damage that daily steroids were doing to me. Google “topical steroid withdrawal”. I know you are on oral rather than topical steroids but I know the damage they did to me even on that low dose so I’d be very worried about someone on a high dose for many years.

Definitely seek medical advice and get a second opinion.

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