Examples

The following medications can be given as an injection:

Generic Name	Brand Name
dexamethasone
methylprednisolone	A-Methapred, Solu-Medrol
triamcinolone acetonide	Kenalog-10

The following medications can be given as pills or liquid:

Generic Name	Brand Name
dexamethasone	Decadron
methylprednisolone	Medrol
prednisolone	Pediapred, Prelone
prednisone

How It Works

All corticosteroids reduce inflammation in the airways that carry air to the lungs (bronchial tubes). They also decrease the mucus made by the bronchial tubes and make it easier for you to breathe.

Systemic corticosteroids travel throughout the body before reaching the airway. This results in more side effects and more serious side effects than with inhaled corticosteroids, which treat inflammation in the airways only.

Why It Is Used

Systemic corticosteroids help control narrowing and inflammation in the airways of the lungs in asthma. They are used to:

• Get relief of asthma symptoms during a moderate or severe asthma attack.
• Get control of symptoms when you start long-term treatment of asthma after your initial diagnosis.

Corticosteroids may make the episode shorter and prevent early recurrence of episodes. The length of treatment with corticosteroids can be different depending on the person. It your attack wasn't very severe, you could take corticosteroids for only 3 days. But you may need to take them for as long as several weeks for a very severe attack.

People with severe persistent asthma may need to take corticosteroid pills or liquid by mouth daily or every other day to control their symptoms.

Different types of medications are often used together in the treatment of asthma. For more information on the medications used in asthma, see:

• Asthma medications for adults, teens, and children older than age 5.
• Asthma medications for children age 5 and younger.

How Well It Works

A review of research shows that treatment with systemic corticosteroids during an asthma attack reduced hospital admissions and the frequency of relapse in adults, teens, and children.^{1, 2}

Research has reported that in children with mild to moderate asthma, oral corticosteroids were no more effective than inhaled corticosteroids in reducing hospital admission after an asthma attack.²

Side Effects

Injections of dexamethasone acetate, although helpful for treating asthma episodes, are thought to suppress the function of the adrenal glands more than oral corticosteroids do.³ If treatment with dexamethasone acetate were continued for a long time, the medication could cause side effects such as delayed growth.

Side effects of long-term treatment with steroids given by mouth (pills and liquid) include:

• Slower growth or stunted growth in children.
• Problems with the body's ability to use glucose (diabetes).
• Bone weakening (osteoporosis) or possibly bone death (aseptic necrosis of the femur) from changes in blood supply.
• High blood pressure (hypertension).
• Repeated infections, bruising, and skin thinning (atrophy). Corticosteroids also make it less likely you will have a fever, so that an infection is not always recognized immediately.
• Clouding of the lens of the eye (cataract).

To minimize or prevent side effects of corticosteroids:

• Keep the dose of corticosteroids as low as possible while still maintaining asthma control.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Steroids by mouth or injection may be given as short-term treatment after an episode or when asthma has not been under control. "Burst" treatment with steroids may be continued for 3 to 14 days or longer. A person who has frequent asthma episodes while being treated with inhaled steroids may need to have the medication increased.

In children, steroid pills reduce the severity and length of an asthma attack. But for the pills to stop an asthma attack, it is important to give them at the first sign of symptoms.⁴

Pregnant women who use steroids by mouth or injection may have babies with low birth weights. If you are pregnant, may become pregnant, or are breast-feeding, talk to your health professional before using these medications.

Women who use steroids by mouth or injection for long periods of time and who have gone through menopause need to take extra calcium and vitamin D, and possibly bisphosphonates (such as Fosamax), to prevent bone loss (osteoporosis).

If you have been using systemic steroids for more than 3 weeks and are going to stop taking them, you need to gradually decrease the amount you use, rather than stopping them all at once. This will help avoid problems with the adrenal glands.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Dennis RJ, et al. (2005). Asthma, search date May 2004. Online version of Clinical Evidence (14): 1847–1877.

2. Keeley D, McKean M (2006). Asthma and other wheezing disorders in children, search date October 2004. Online version of Clinical Evidence (15): 1–25.

3. Gries DM, et al. (2000). A single dose of intramuscularly administered dexamethasone acetate is as effective as oral prednisone to treat asthma exacerbations in young children. Journal of Pediatrics, 136(3): 298–303.

4. Rachelefsky G (2003). Treating exacerbations of asthma in children: The role of systemic corticosteroids. Pediatrics, 112(2): 382–397.