Yes, inhaled steroids can cause systemic problems!

If you, or anyone you know has asthma, this is a post you should read.

First line treatment for asthma is what is referred to as a rescue inhaler. This is the albuterol inhaler that asthmatics use at the first feeling of asthma and will cause rapid dilation of the bronchial tubes to help breathing get easier and can help to avoid a more serious attack. These medications fall into the class of short acting beta agonist. This just means that they have a short term effect on the beta receptors in the lungs, which allow the relaxation to happen.

However, for those people who have continued issues with asthma control, the second step is generally to add in a steroid inhaler. Inhaled steroids address the inflammation in the airways (vs. the albuterol which dilates the bronchioles) and are used as a regular daily medication for more long term control.

Steroids, given in oral form (i.e. prednisone) are well known to have major effects in the body. Steroids are well known to increase blood sugar and can worsen or induce diabetes, can deplete bones leading to osteopenia and osteoporosis, cause weight gain, cause cataracts, decrease growth (most obvious in kids), depress the immune system leading to higher risks of infections, affect wound healing, can have profound mental effects, and can in some cases permanently damage the adrenal glands if a proper taper is not done at the end of the course.

For many decades, the medical mantra has been that inhaled steroids did not carry these same risks. However, studies have questioned this for a long time and most recently, in 2014, several reviews of the literature showed that inhaled steroids could lead to some of the same systemic and long term side effects as oral steroids. Many practitioners, including many pulmonologists still deny this and regularly assure patients that long term use of inhaled steroids will have minimal or negligible systemic effects. This is just not true!

The effects are, as would be expected, seen more with higher doses of inhaled steroids, but even some moderate and lower doses have shown effect, particularly long term. Some steroids were shown to be more risky than others, with fluticasone (trade name Flovent) showing a higher risk profile than other steroids such as budesonide (Pulmicort).

So what to do? DON'T STOP YOUR INHALER! Obviously breathing is key to life, so it is never a good idea to suddenly stop any inhaled steroid as this could lead to increased asthma, which can be life threatening. The better idea is to use this research as a conversation point with your doctor, either primary care or pulmonologist to try and minimize your risks. Considering the lowest dose which is effective or switching to a different steroid are two possibilities. Or you could see a naturopathic physician to try and work on the underlying cause of asthma. Yes, it is possible to reverse asthma and yes, some patients can safely get off long term steroid inhalers by modifying lifestyle, diet, and using natural approaches to optimizing health. Additionally, for patients for whom it's not safe to remove the steroids, naturopathic physicians learn many tools to help support your body in minimizing the side effects of long term steroid use and can help to design a custom plan to help your body cope with these medications.

References:

Chee, C., Sellehewa, L., Pappachan, J. Inhaled Corticosteroids and Bone Health. The Open Respiratory Medicine Journal, 2014, 8, (Suppl 1: M5) 85-92.

Egbuonu, F., Antonio, F., Edavalath, M. Effect of Inhaled Corticosteroids on Glycemic Status. The Open Respiratory Medicine Journal, 2014, 8, (Suppl 1: M7) 101-105.

Pandya, D., PUttanna, A., Balagopal, V. Systemic Effects of Inhaled Corticosteroids: An Overview. The Open Respiratory Medicine Journal, 2014, 8, (Supple 1: M2) 59-65.