Ep. 105: Understanding Oral Corticosteroid Overuse in Asthma
Part of the series: Allergy, Asthma & Immunology Innovations Podcast
This podcast was made in partnership with Allergy & Asthma Network.
We thank Sanofi and Regeneron for sponsoring this episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.
LISTEN TO EPISODE 105:
Ever wonder if the “asthma shot” from the ER, or those go-to steroid pills for your asthma flares, might be doing more harm than good?
Dr. Dipa Sheth joins us to discuss the common pitfalls of relying too heavily on oral corticosteroids (OCS), also known as oral steroids. We unpack why these systemic medications should generally be reserved for short-term use. She also shares how improving asthma control can help you avoid frequent steroid use in the first place.
Although oral steroids can effectively treat asthma flare-ups in emergency settings, overuse poses significant risks, from adrenal insufficiency to osteoporosis. We dig into ways patients can proactively manage their asthma, reduce ER visits, and talk to healthcare providers about preventive treatments (like inhalers or biologics for asthma) that keep inflammation in check without the side effects of frequent steroid use.
Note: Although we discuss oral corticoid steroids, they can also be given as injections or via IV drip for asthma. We would also like to refer to them as systemic steroids as they impact the entire body, unlike inhaled steroids, which target the airways and lungs.
What we cover in our episode about the risks of oral steroids for asthma:
Understanding Oral Corticosteroids (OCS): Learn what these steroids (often called the “asthma shot” in the ER) are and how they can help with severe flare-ups.
Why Overusing Steroids Can Be Risky: Discover the potential long-term side effects of relying on systemic steroids (pills, injections, or IV), from adrenal insufficiency and osteoporosis to more frequent infections.
Short-Term Fix vs. Lasting Relief for Asthma Care: Learn how urgent care or ER visits may mask an under-managed condition and why seeing a specialist can improve asthma control.
Safer Alternatives to OCS: Explore inhaled corticosteroids, biologics, and other preventive treatments that target asthma at its source, reducing the need for frequent steroids.
Taking Control and Reducing ER Visits: Get practical strategies for working with your healthcare provider to minimize steroid use, prevent flare-ups, and break free from the cycle of repeated steroid courses.
About our OCS in asthma expert: Dr. Sheth
Dr. Dipa Sheth, MD is an Assistant Professor in the Division of Allergy and Immunology at the George Washington University School of Medicine and Health Sciences. She is board-certified in Allergy and Immunology and has dedicated her career to advancing patient care in asthma and allergic disorders.
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Other episodes about asthma treatments
More resources about steroids and asthma treatments
Key takeaways about steroid overuse in asthma
Red flags: overuse of steroids is a sign of poor asthma control
Frequent ER Visits: Relying on the “asthma shot” (steroid injection or IV) or steroid pills more than once or twice a year strongly indicates that your asthma isn’t well-controlled.
Masking the Underlying Issue: Frequent reliance on steroids may hide deficiencies in your long-term treatment plan or preventive care strategy.
Consequences of excess steroid use
Bone Health and Osteoporosis: Steroids can accelerate bone loss, increasing the risk of fractures and osteoporosis, especially in older adults or those with nutritional deficiencies (NHLBI Guidelines, 2007).
Weight Gain & Increased Appetite: Fluid retention and a surge in appetite can lead to rapid weight gain.
Hyperglycemia/Diabetes: Long-term use can impair blood sugar control, sometimes triggering steroid-induced diabetes (Cleveland Clinic, 2022).
Cardiovascular Risks: Prolonged steroid use may elevate blood pressure and increase the risk of cardiovascular events.
Skin Thinning & Bruising: Steroids can cause fragile skin that bruises easily and may lead to stretch marks (striae).
Acne: Some patients experience acne or other skin eruptions.
Ocular Complications: Prolonged use is linked to cataracts and increased intraocular pressure, which can lead to glaucoma.
Mood and Cognitive Effects: Steroid use can trigger mood swings, anxiety, irritability, insomnia, and, in some cases, depression or cognitive impairments (AAAAI, 2021).
Immunosuppression: A weakened immune response makes you more susceptible to infections, from minor colds to more serious illnesses.
Gastrointestinal Issues: There is an increased risk of stomach ulcers and gastrointestinal discomfort with prolonged steroid use.
Safer alternatives and preventive Care for asthma
Inhaled Corticosteroids (ICS): Daily low-dose inhalers target inflammation directly in the airways with fewer systemic side effects, forming the foundation of long-term asthma control (GINA, 2023).
Biologics for Asthma: These targeted therapies (e.g., omalizumab, dupilumab) address specific immune pathways to reduce flare-ups, thereby minimizing the need for OCS (AAAAI, 2021).
Lifestyle Adjustments: Avoiding known triggers, adhering to proper inhaler techniques, and following a structured asthma action plan can significantly reduce the risk of severe flare-ups.
Partner with specialists and advocate for better access
Why See a Specialist? An allergist or pulmonologist can fine-tune your treatment plan, monitor subtle changes in your condition, and adjust medications to minimize steroid use.
Overcoming Disparities: In underserved communities, limited access to specialists can lead to higher reliance on ER visits and steroids. Utilize telehealth, local advocacy groups, and patient support networks to access optimal care.
Taking Control: Openly discuss your steroid use with your healthcare provider. Ask about updating your treatment with alternatives such as inhalers or biologics, and commit to a proactive, long-term management strategy.
Sources
Mayo Clinic, 2023 – Overview of corticosteroid side effects and adrenal insufficiency: MayoClinic.org
NHLBI Guidelines (Expert Panel Report 3), 2007 – Comprehensive asthma management guidelines: NHLBI.nih.gov
Cleveland Clinic, 2022 – Information on long-term steroid use and metabolic changes: ClevelandClinic.org
AAAAI (American Academy of Allergy, Asthma & Immunology), 2021 – Guidelines and resources on asthma management and steroid side effects: AAAAI.org
GINA (Global Initiative for Asthma), 2023 – Global recommendations on asthma management, including inhaled corticosteroids: GINAasthma.org
Timestamps
Our episode explores the negative impact of steroid overuse in treating asthma
01:25 Introduction: Dr. Dipa Sheth
01:58 Overview of oral corticosteroids for asthma
03:30 Speed of steroid action
04:40 Mechanism of action and medications for asthma
06:16 Medications administered in the ER for asthma
08:04 Optimal approaches to treat inflammatory asthma
09:55 Limitations of urgent care and ER in asthma management
11:26 Risks of overusing oral steroids in asthma
14:10 Identifying excessive oral corticosteroid use
14:45 Strategies to prevent overuse of OCS and ER visits
17:25 Impact of OCS overuse and limited access to care
20:59 Recognizing uncontrolled asthma between ER visits
23:20 Terminology: systemic steroids vs. inhaled corticosteroids
