INHALED CORTICOSTERIODS - a patient's guide
Contains Beclomethasone, Budesonide or Fluticasone.
- These medicines are all corticosteroids.
- Beclomethasone is the medicine in Becotide, Respocort, Becodisk and Becloforte.
- Budesonide is the medicine in Pulmicort.
- Fluticasone is the medicine in Flixotide.
There are several different devices to help these medicines get into the lungs.
- Metered dose inhalers &endash; you need to co-ordinate breathing in with pressing the inhaler. Always shake before use.
- Breath activated inhalers &endash; like the metered dose inhaler but when you breathe in the inhaler is activated, releasing the dose. Always shake before use.
- Turbuhalers &endash; dry powder in an inhaler device, you twist the bottom of the turbuhaler to get the dose ready to inhale.
- Diskhalers and Accuhalers also contain dry powder in individual doses. You need to pierce the foil using the diskhaler or accuhaler then the powder is ready for breathing in.
All the devices work well. Find the one that is easiest for you to use. Watch yourself in the mirror to make sure your airways are straight so the medicine will get to the lungs. Do not hunch over when you are using them.
USE: To make the breathing passages less reactive.
In asthma the airways are over-reactive. They can over-react to stress, sudden cold air, exercise, pollen, other allergens or infection. In these cases the airways can become inflamed and swollen ,triggering changes which mean that the air has less room to pass through, making breathing more difficult and causing coughing or wheezing. See Asthma article for more details.
Corticosteroids (also called steroids) settle down the breathing passages. They reduce inflammation and make the breathing passages less reactive, so that asthma attacks, coughing and wheezing happen less often.
These medicines need to be used every day to keep the airways in good order. They do not have their best effect the first time they are used, they need to be used for a few days or more to work, and in fact they work their best after a few weeks or more of being used every day. So, most asthmatics will use them every day all year around to always get the best effect from them.
Does every asthmatic need to use steroid inhalers?
No, not every asthmatic will need to use these. Your doctor is best to guide you on this. People with very mild asthma will often only use a reliever inhaler (e.g. Ventolin) in the rare times they have wheezing or shortness of breath, and do not need a steroid inhaler as well. However, for anyone who uses their reliever more than a couple of times a week, a steroid inhaler is often recommended.
How do I know if I need a steroid inhaler?
Talk about steroid inhalers with your doctor, and use his or her guidance. Steroid inhalers are often recommended for anyone using their reliever (e.g. Ventolin) more than a couple of times a week. People who have more severe and persistent symptoms are more likely to benefit from an inhaled steroid.
Can I use my steroid inhaler like a reliever?
Steroid inhalers do not open the airways in a hurry like relievers do. They are not used when you are having an asthma attack to help the breathing quickly. Their effect takes longer to build up.
Will my child be short if he uses steroids?
Most children who have asthma and are on steroids by inhaler will not be any shorter than other kids their age. But a study in the British Medical Journal in February 1998 found that children with very bad asthma requiring hospital treatment and high doses of inhaled steroids have been found to have slower growth. It isn't known if they grew a little slower because of the high doses of steroids or because of the asthma being so bad.
In standard and lower doses,inhaled steroids appear to be very safe to use in childhood asthma. Their use and benefit needs to be balanced against the risks of untreated moderate and severe asthma .
Will I get acne or get a deep voice by using inhaled steroids for asthma?
These steroids are different to the anabolic steroids used by body builders. Inhaled steroids for asthma do not cause male hormone effects such as acne, deep voice or muscle growth.
What side effects do inhaled steroids cause?
Having the steroids go directly into the lungs using an inhaler, accuhaler or diskhaler means that a lot less steroid goes around the rest of the body than if the steroid is taken in a tablet. This means that systemic side effects of inhaled steroids are not a problem for most people.
If systemic effects do occur,they are usually from very high doses of inhaled steroids.(higher than average prescribed dosages).
Side effects are not common with inhaled steroids. In virtually all cases the benefit of inhaled steroids are far greater than any problems with side effects.
Some side effects include ;
- Irritation of the throat, tongue and mouth.
- Coughing and husky voice
- Dry mouth and thirst
- Bad taste
- Candida infection in the mouth or throat (rinse your mouth with water after using the inhaler and this shouldn't happen).
The following side effects are even less common, particularly at the usual doses:
- Headache, light-headedness, stomach upset and tiredness
- Nervousness or restlessness
- Slower growth in children (high doses only)
- Bones become less dense
- Adrenal suppression
- Cataract, glaucoma
In very rare cases using an inhaled steroid can cause a wheeze straight after taking a dose. Stop using and talk to your doctor immediately.
There may be other side effects, so if you have any unexpected symptoms while taking this medicine, tell your doctor or pharmacist.
What will happen if I stop using my steroid inhaler?
Sometimes your asthma will stay the same for a while then it may gradually get worse. Or it may get worse quickly. If you are thinking of stopping the steroid inhaler, discuss it with your doctor first &endash; he/she will know how bad your asthma is and will be able to advise you.
Once I am on inhaled steroids will I always have to take them?
This depends on your asthma. There is a trend to slowly reduce the dosage as far as possible,once asthma is well stabilised, as long as symptoms remain well controlled.
Examples of when people might stop using the steroid inhaler are:
- Those with very mild asthma that just had a bad patch &endash; e.g. a bad winter.
- Children may grow out of their asthma and no longer need the steroid inhalers.
- Some people with lung diseases other than asthma (e.g. emphysema) may find that the steroid inhaler doesn't help their lungs, so there is no point staying on it.
- Someone who moves town and finds that their asthma improves
In all cases stopping using an inhaled steroid should only be done in consultation with your doctor.
Why can't I just use the steroid inhaler if I have an attack?
The steroid inhaler takes time to get to best effect. If you wait until you have an attack it will not work as quickly or as well as if you used the inhaler regularly before the attack &endash; and the steroid inhaler may have prevented that attack.
Should I use more of my inhaled steroid if my asthma gets worse, e.g. if I have a cold?
It is common to use more puffs of your steroid inhaler during a bad patch. Your doctor should be able to help you with an action plan. Using a peak flow meter regularly means you know how your asthma is and the action plan tells you what to do when your asthma worsens. Only change your dose according to your doctor's instructions.
Will inhaled steroids help emphysema?
Sometimes inhaled steroids help chronic obstructive pulmonary disease (COPD), and sometimes they do not, depending on your lung condition. Often these medicines are tried and if they are doing any good, great, if not they are stopped.
Will inhaled steroids make my lungs weaker?
No, inhaled steroids will make your asthma better controlled, so you will feel better. They do not have any bad effects on the lungs.
How do I know if my inhaler is nearly empty?
You can usually take the canister out and put it into a bowl of water. If it floats it is nearly empty.
Can I get addicted to steroid inhalers?
No, you do not get addicted to steroid inhalers. However, do not stop using them without talking to your doctor first.
Can I use inhaled steroids in competitive sport?
The International Olympic Committee requires that corticosteroids used by inhalation is reported in writing by a doctor. They can be used in this case.
Fluticasone may interact with medicines such as ketoconazole (Nizoral) and ritonavir (Norvir).
- Follow the instructions on the label of the medicine or as directed by your doctor.
- Use your inhaled steroids every day even when you are feeling well.
- See your doctor if you are using the reliever more often than usual because your asthma may be going through a bad patch and your doctor may need to alter your medicine.
- Talk to your doctor about action plans and peak flow meters. Both of these can help very much with your asthma control.
- See information on spacers : spacers can help the medicine get to your lungs more effectively and reduce the amount of the steroids in the mouth.
- Rinse your mouth out, or brush your teeth after using the inhaler. This prevents a candida infection in the mouth.
- If you get white patches in the mouth that can be sore it may be candida and will need treatment
- Don't run out of this medicine, you should be taking it every day.
- If using a metered dose inhaler, shake it well before use.