Steroids in Asthma
Asthma is a condition that affects the airways - the small tubes that carry air in and out of the lungs. It is an inflammatory disorder of the airways characterized by attacks of wheezing, shortness of breath, chest tightness and coughing.
Causes, Incidence and Risk Factors
Asthma is characterized by inflammation in the airways. During an asthma attack, the muscles surrounding the airways become tight and the inner lining of the airways swell. This causes reduction in the amount of air that can pass through these air passages.
In sensitive people, asthma attacks can be triggered by allergy causing substances which are known as allergens. Common allergens are:
2. Animals (pet hair or dander)
3. Chemicals in air or food
4. Changes in weather (especially cold weather)
6. Mold and pollen
7. Emotional stress
8. Tobacco smoke
9. Respiratory infections like the common cold
10. Aspirin and other NSAIDs in some patients
Some patients have a family history of asthma or other allergies like hay fever or eczema.
Asthma is usually characterized by acute attacks followed by symptom free periods. The attack can last for minutes to days. It can become dangerous and an emergency if the airway is severely restricted.
The common symptoms are coughing, wheezing and shortness of breath. In severe attacks, a bluish color of the lips or face, drowsiness, anxiety, rapid pulse and extreme difficulty in breathing can occur.
Management and Treatment
The aim of treatment is to prevent acute attacks and reduce inflammation of the airways. Contact with allergens which are known to trigger acute attacks is to be avoided. Drug therapy of asthma consists of two modalities:
1. Drugs to prevent acute attacks
2. Quick relief drugs during acute attacks
Steroids form an important part of management of acute attacks as well as long term control. When used for long term, they are usually combined with beta agonists. Steroids are usually given as inhalers. Steroids decrease the inflammation and swelling of the airways as well as control the allergic reaction which triggers the asthma attack.
Steroid Taper in Asthma
Steroids cannot be continued indefinitely as they have adverse effects when used for long term. Also, prolonged use can cause tolerance and their efficacy decreases. This will also decrease their ability to control acute attacks effectively. Hence steroid taper in asthma forms an integral part of management.
Tapering of steroids means decreasing the doses of steroids gradually to a minimum dose and then stopping it altogether. This is done slowly so that the body gets used to the decreasing doses. Sudden stoppage will cause rebound attacks of asthma which can be severe.
However, when steroids are given for a very short period of time, say 5-10 days, there is no need to taper off the dose. They can be stopped abruptly. When steroids are used for a longer period of time, dose tapering is necessary.
Steroids are usually tapered by every 5-10 mg from the original dose at a fixed interval of time and when a minimum dosage of 5-10 mg is reached, they can be stopped altogether. In the case of inhaled steroids, the number of puffs per day are decreased, then puffs are taken every alternate day and then altogether stopped.
The commonly used inhaled steroids in asthma are flunisolide, budesonide, mometasone, beclomethasone and fluticasone. These are delivered to the airways using a metered dose inhaler and spacer. Occasionally, in case of severe symptoms, oral steroids are prescribed for a short duration of time. The commonly used steroids are prednisone, prednisolone and methylprednisolone.
Thus, steroid taper in asthma forms an important part of long term management of asthma and should be done under the supervision of a qualified medical practitioner in order to avoid adverse effects.
1. Emergency Asthma by Barry E Brenner, 1999
2. ABC of Asthma by John Rees, Dipak Kanabar, Shriti Pattani, 2010