Oral Corticosteroids for Asthma

What is OCS?

OCS stands for oral corticosteroid. This means the medication is swallowed and distributes throughout your body, not just your airways. A corticosteroid is a medication that decreases your body’s inflammatory response. They are used for treating many conditions. You may be prescribed an oral corticosteroid for asthma, chronic obstructive pulmonary disease (COPD), or allergic reactions.

Another term for OCS is “glucocorticoid”.

An oral corticosteroid may be given in the form of a pill, a liquid, or even intravenously if you are in the hospital. You will usually take this medication for 5-10 days. Children will take OCS medication for a shorter period of time.

Oral corticosteroids may be referred to as “rescue medication” or “steroid tablets”.

OCS are not the same as anabolic steroids, which are based on the hormone testosterone. Anabolic steroids are a type of medication sometimes taken without medical advice to increase muscle mass and improve athletic performance. These types of steroids are banned in many athletic events.

Types of oral corticosteroids include: Prednisone, methylprednisolone, hydrocortisone

Who uses OCS?

Most people with asthma do not use oral corticosteroids as part of their treatment plan. Oral corticosteroids can be used to treat uncontrolled asthma or in some cases, severe asthma. Oral corticosteroids may also be used in the emergency department when urgent treatment is needed, during or just after an asthma attack.

If you have severe asthma, you may be prescribed oral corticosteroids long-term. Your health care provider will only prescribe oral corticosteroids if it is absolutely necessary to prevent you from having severe or uncontrolled asthma symptoms.

Approximately 30% of adults with severe asthma are considered corticosteroid-dependent, meaning that chronic OCS are required in addition to inhaled corticosteroids (ICS) and other controllers to achieve and maintain control of their asthma. (Source: CTS Statement)

If you need more than two courses/prescriptions of oral corticosteroids in a year, this is a sign that your asthma is uncontrolled.

It is important that you speak with your health care provider right away to determine ways to improve your asthma control.

ICS vs. OCS

Your health care provider may have prescribed you an inhaled corticosteroid (ICS). ICS are the most effective anti-inflammatory medications for asthma. Inhaled corticosteroids are taken through an inhaler or nebulizer. ICS reduce symptoms, increase lung function, quality of life, and reduce the risk of exacerbations and asthma-related hospitalizations or death. These medications are delivered into the lungs and are not designed to circulate throughout your body. There are specific corticosteroids designed for inhalers and these medications are different than the OCS.

Types of inhaled corticosteroids include: Beclomethasone, budesonide, ciclesonide, fluticasone propionate, fluticasone furoate, mometasone, triamcinolone.

ICS

Inhaled corticosteroids

Inhaled corticosteroids are taken through an inhaler or nebulizer. The medication is inhaled directly into your lungs and airways. Inhaled corticosteroids are a maintenance treatment for asthma.
ICS are taken daily to maintain asthma control for 12-24 hours.
ICS treats your lungs and airways only, so the medication does not destribute throughout your body. This means you do not experience harmful side effects that can occur with OCS.

OCS

Oral corticosteroids

Oral corticosteroids are taken by pill or even sometimes intravenously to treat severe asthma symptoms or exacerbation. The medication travels through the bloodstream and affects other parts of your body.
OCS are typically taken as a short-term medication (5-7 days) for severe, acute asthma symptoms, but can sometimes be used more frequently to treat severe asthma.
OCS enter other systems in your body, not just the lungs, so your body is exposed to more medication and there is a higher risk of severe side effects.

Benefits and Risks of Oral Corticosteroids

For decades, OCS have been an important treatment for the management of severe asthma, uncontrolled asthma, and acute asthma exacerbations (attacks) in both children and adults. However, prolonged use of OCS has severe health implications. OCS use has a cumulative effect on a person over their lifetime, and relying on this form of treatment can cause significant health effects.

Even short-term low dose use of OCS (under 30 days) can result in serious health problems, including:

Fluid retention
High blood pressure
Problems with mood swings, memory, behavior, and other psychological effects
Upset stomach
Weight gain

Longer-term effects include:

Cataracts/glaucoma
Trouble sleeping/disruption of your sleep cycle
Depression, mood disturbances, irritability
High blood pressure (hypertension)
Adrenal suppression (suppression of your body’s stress response)
Weight gain
Increased appetite
Heartburn (acid reflux)
Bone loss (osteoporosis)
Thinning of the skin/skin tears/bruising

OCS can be an important and necessary tool for some people with asthma to manage their asthma. However, it is crucial that this treatment be carefully managed, monitored, and supported by an asthma specialist or health care provider who specializes in asthma.