November 2, 2015

Provider prescribed steroids. What do you need to know? Is there a concern? (By request.)

When your child gets an illness like viral croup or has an asthma exacerbation, their provider may prescribe an oral steroid to stem the tide of decompensation that can land your child in the ER or worse the hospital. As someone that writes for these medicines, I feel that it is important for you to be aware of the risk/benefit ratio.

Steroids are synthetic chemicals that we use to block serious inflammatory reactions that occur in response to an allergen, an infection or autoimmunity. These drugs have the ability to shut down the reaction that produces three classes of inflammation inducing chemicals called leukotrienes, prostaglandins and thromboxanes. Because of this ability, these medicines are prized for preventing death and morbidity. They work tremendously well.

Why then are we not using them like water? As with any great medicine, there is no free lunch. The side effect potential of such a potent inflammatory inhibitor is profound and worsens with higher doses and increasing length of use. Most of the side effects in the short term, less than 1 week, are related to mood swings and blood sugar spikes that are generally not a big deal unless you are diabetic. We still only choose to use steroids only when it is absolutely necessary.

The real issues begin when the drug is used for weeks.

Chronic steroid use suppresses our natural steroid production in the adrenal gland and causes side effects like weight gain, increased infection risk, cataracts, high blood pressure, thinning skin, osteoporosis and so on. You get the picture. Not a pretty one.

As of 2015, short courses of steroids where necessary are a good choice if they are used to prevent serious morbidity or death for acute conditions. Asthma exacerbations, severe poison ivy, severe croup, autoimmune disease flairs and others...may warrant drug use.

Useful when necessary,

Dr. M