heather, whenever i mentioned the use of steroids, inhaled steroids, in asthma my patients get very nervous with a lot of questions about, you know, what are the side effects of these medications? they have the image of bodybuilders with all the negative effects of steroids use. how do you discuss that? what are the side effects of these drugs, how do you couch it and talk about this with your patients? well, i think the concerns that come
from the use of inhaled steroids stem back to known side effects that we know about with oral steroids or steroids pills that have to be taken on a regular basis. these steroid pills are not anabolic steroids that build muscles, they are corticosteroids that actually can have very different side effects. there can be weight gain, decreased bone density leading to osteopenia or osteoporosis, increased blood pressure, predisposition to developing diabetes, cataracts, glaucoma. so some very serious side effects with these oral steroids being used chronically. and while the inhaled steroids are the same basic medications,
theyâ€™re used at a much, much, much smaller dose, and theyâ€™re targeted to go directly to the lung and have as little absorption throughout the rest of the body as possible. so the goal is to target the part of the body that we really need to treat with the steroids, without dealing with all the body-wide side effects. that being said, they're not completely without risk of side effects. high dose inhaled steroids used on a long-term basis can have a little bit of the medication get into the body-wide circulation, into what we call that the systemic circulation.
so there can be some small increased risk of things like cataracts, glaucoma, decreased bone density, increased blood pressure, things like that. but we do have to balance that with the risks of not using these medications, and that's the risk of uncontrolled asthma. so not only if you don't use your inhaled steroids if they've been prescribed regularly can you have uncontrolled asthma, you can actually have an asthma attack that makes your doctor have to give you those oral steroids, those higher dose medications again. and those are the ones we know can really wreak havoc on the body.
for children as well there's been a question what can inhaled steroids do to growth? that was something that was questioned for years without a clear, clear answer. but now there have been some very good studies that have suggested that yes, there is a small, small impact on the final adult height of a child who has taken inhaled steroids at a decent dose during their critical growing years. but again we have to balance that, if that's a child that otherwise would be on oral steroids multiple times in a winter each of those years, we know that steroid dose would be much worse and the effect could be much worse. so if it's the appropriate medicine for you,
if your asthma is not controlled and it's required, in most cases the benefits do outweigh the risks. there are a couple of local side effects too which i'm sure you see too. you do get this thrush which is a fungus infection in the throat, but it's easily preventable. essentially after you take the inhaled steroids you should rinse and gargle so that the local steroid deposition is cleared. so that's one effect, and even if it does happen it's easily treatable. the other thing which i see sometimes is changes in voice like hoarseness, and that again is because of the medication depositing on the way down into the lungs on the vocal cords.
and again, usually for that i just need to change the inhaled steroid i am using, or the delivery device i am using and that seems to fix the problem.