Take a breath before giving asthma patients steroids, experts say

Asthma patients are being given too many steroid tablets, a group of researchers say, potentially exposing long-term sufferers to serious side-effects.

Steroid tablets are commonly prescribed to people who have recently had a serious asthma attack to prevent another attack.

But the researchers, led by University of Queensland Professor John Upham, found that while there is significant benefit in the short term from the treatment, the long-term effects may outweigh any benefit gained.

"Doctors used to think that if you just have a short course of these tablets for a few days it didn’t really matter and you would only suffer side-effects if you took them day after day for a long period," Professor Upham said.

"But we’re realising if you have repeated bouts of steroid tablets on multiple occasions over the course of a year that actually can result in side-effects as well."

The research team, which also included scientists from Melbourne, Newcastle, Perth and Sydney, analysed data from the national Pharmaceutical Benefits Scheme to find patients given repeated courses of steroid tablets.

They found more than 120,000 such cases between 2014 and 2018, and identified nearly a quarter were in the high risk category for chronic conditions including diabetes and osteoporosis due to the level of oral steroids they were taking.

"Those conditions have been identified as a known side-effect of prolonged use of steroid tablets, the more you use them the more likely you are to get the complications," Professor Upham said.

"There was a lot of risk going on that didn’t need to be there."

About 2.5 million Australian have some form of asthma, with more women suffering from the condition than men.

Professor Upham said that in contrast to steroids in tablet form, steroid inhalers had very few side-effects and were just as effective at preventing severe asthma attacks from recurring.

"Steroids taken through an inhaler are very safe, people occasionally get a bit of a reaction in their throat but that’s it, the steroid doesn’t get into the rest of their body," he said.

"In tablets it goes all the way through your body and can affect everything from your brain, your bones, your skin, the whole box and dice.

"Sometimes they really are life-saving, but if the same person is having to take them over and over again you need to be thinking what else is going on, what can we do to prevent these attacks from happening."

The research team is calling for the use of steroid tablets to be greatly reduced at the prescribing doctor level.

Professor Upham said patients should also feel empowered to ask their doctor to explore other options beyond steroid tablets.

"Better approaches are needed to educate and support asthma patients, and encourage them to use preventer inhalers regularly," he said.

"This is the best way to avoid or minimise the need for steroid tablets, and the side effects they can produce."

The findings have been published in the Medical Journal of Australia.