The Potential Risks of Repeated Corticosteroid Use

Corticosteroids, also known as steroids, are a powerful and popular medication used to treat various conditions, including chronic lung diseases. By mimicking cortisone production, these medications help reduce and control inflammation in the body. In higher doses, they can also be used to suppress the immune system, for instance when it may attack its own tissue, like after an organ transplant. Though these medications are very useful for a variety of illnesses, they may come with side-effects. In fact, long-term oral systemic corticosteroid users are at great risk of serious side effects, which is why their healthcare providers need to monitor them closely. We spoke with Dr. Payel Gupta, an Assistant Clinical Professor at SUNY Downstate Medical Center and a clinical instructor at Mt. Sinai Medical Center, about possible benefits and dangers of ongoing or long-term (daily) oral systemic corticosteroid use.

Why Are Corticosteroids Used?

“Corticosteroids are used to treat a wide range of inflammatory and autoimmune conditions, including allergies, asthma, COPD, rheumatoid arthritis, lupus, eczema and psoriasis and even cancers,” Dr. Gupta explained.

Specifically for chronic lung diseases, inflammation is the first signal that fibrosis (scarring) may be occurring, so corticosteroids can be used to prevent this damage. For people with asthma, the regular use of inhaled corticosteroids can manage and prevent severe symptoms and flare-ups. Asthma flare-ups happen when there is inflammation of the bronchial tubes in the lung, and this is what the inhaled medication eases. Similarly, people with COPD, including those managing chronic bronchitis and emphysema, have lung inflammation that creates swelling and narrowing of the airways and increases mucus. Inhaled corticosteroids can help prevent flare-ups if used daily, which can forestall the need for oral corticosteroids to be needed. For inflammatory conditions like pulmonary fibrosis and sarcoidosis, daily, oral or systemic corticosteroids control inflammation in the lungs and other organs and help slow the overall progression of the disease.

What are the side effects of oral corticosteroids? 

Corticosteroids can be life-saving medicine, and many times the benefits outweigh the side effects. “Systemic Oral Corticosteroids can be highly effective, especially in the short term, for rapidly reducing lung inflammation and controlling symptoms of severe respiratory conditions,” said Dr. Gupta. “However, they do come with a range of potential side effects, particularly with long-term use.”

Side effects are more common for long-term use, or when higher doses are administered, but anyone who uses oral corticosteroids could develop one or more of these side effects. Some of the most common side effects of oral corticosteroid use include:

• Weight gain
• Fluid retention resulting in puffiness or swelling
• Increased blood sugar levels
• High blood pressure
• Bone thinning (osteoporosis)
• Increased risk of infections
• Mood swings
• Eye problems like glaucoma or cataracts

Given these risks, oral corticosteroids are often used for short-term relief or during flare-ups of chronic lung conditions. For long-term management, healthcare providers may recommend alternative treatments, including inhaled corticosteroids, with fewer side effects. The best option depends on the severity of your condition, how you respond to treatment, and your overall health.

How can I minimize side effects?

You are at greater risk of developing a respiratory infection when taking an oral corticosteroid, so it is especially important to stay healthy through good hygiene and avoiding people who are ill during your course of treatment.

Many physicians suggest simple lifestyle changes to help decrease the side effects caused by oral corticosteroid use. For instance, always taking your medication with food and water can minimize stomach irritation.

Bone health is a big concern with long-term oral corticosteroid use so your doctor may suggest adding more calcium and vitamin D, whether through food or supplements, to increase and maintain good bone density. Weightlifting exercises are another good way to strengthen bones and muscles.

“For patients with comorbidities like diabetes, I suggest closely monitoring blood sugar levels, as oral corticosteroids can cause them to rise,” Dr. Gupta said. “Your healthcare provider may have additional suggestions which is why you should give them a complete history including other medical conditions and medications you are on.”

What monitoring will I need?

“Regular check-ins with your healthcare provider are crucial when you're on oral corticosteroids, especially if you're using them long-term,” Dr. Gupta explained. It is important to work closely with your healthcare provider so that they can monitor your blood pressure, blood sugar and bone density. They will need to evaluate your overall response to the medication and make any necessary adjustments to your treatment plan to minimize side effects.

The frequency of these check-ins will depend on the dosage and duration of your treatment, but they are typically more frequent if you are on long-term therapy. If your healthcare provider determines that you can stop oral corticosteroid usage, they will want to gradually taper the dosage to prevent withdrawal symptoms. For this reason, it is important that you do not stop your medications without consulting your healthcare provider.

Due to the potential for serious side effects, oral corticosteroids are generally recommended for short-term use or during flare-ups (e.g. asthma or COPD). The decision to use oral corticosteroids should always be personalized, considering the benefits and risks for each individual. Keep yourself informed about your condition and treatment options and discuss any concerns or side effects with your healthcare provider to ensure your treatment plan is the best fit for you. “By staying proactive in managing your treatment and regularly consulting with your healthcare provider, you can effectively use all forms of corticosteroids while minimizing potential risks,” said Dr. Gupta.