Long term steroid use: Experts explain ways to manage side effects

It was during the second wave of coronavirus in India when the administration or rather the misuse of steroids on COVID-19 patients led to an uproar and caused unprecedented health challenges. From severe side effects to a rare but aggressive fungal infection, steroid use became infamously popular for treating patients with COVID but with heightened risks.

However, use of steroids is not something new in the medical field and has been ongoing even before the onset of the SARs-CoV-2 infections. It is used to treat several conditions wherein the body’s defense system does not function properly and causes tissue damage.

According to Dr. Sunil Kumar K, Lead Consultant – Interventional Pulmonology, Aster CMI Hospital, steroids (corticosteroids) are anti-inflammatory medicines used to treat a range of conditions. They are among the medications commonly prescribed to people with many pulmonary conditions such as severe Asthma, interstitial lung disease, respiratory distress syndrome (RDS), COPD, etc.

Dr. Nimish Shah, Consultant Pulmonologist, Jaslok Hospital adds suggesting that certain conditions like inflammation of the heart muscle or lining like Sarcoidosis, meningitis, vasculitis, arthritis, myositis, dermatitis, inflammatory bowel diseases, rhinitis, and certain cancers could also lead to the use of steroids.

Usually steroids are prescribed for short-term use, leading to very few side effects. However, most side effects are likely to occur if the course of steroid use is prolonged i.e. more than 2–3 months.

How to take care of side effects from long term steroid use

Long term use of steroids can affect every part of the body, which is why doctors usually prescribe this medication only when the benefits outweigh the risks.

That said, if you’re someone who requires high doses of steroids, Dr. Sunil recommends seeing your doctor regularly to check for side effects.

“It is recommended that standard protocols for use of steroids should be followed, always keeping a watch on the potential hazards of prolonged use. The key is to get the most benefit from these medications with the least amount of risk. When starting corticosteroid therapy, check with your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily,” he explains.

Furthermore, inhaled corticosteroids for asthma to reach lung surfaces directly can help reduce the exposure to the rest of the body leading to fewer side effects, he opines.

Given that long-term corticosteroid therapy may also cause thinning bones (osteoporosis), the doctor recommends taking calcium and vitamin D supplements to help protect the bones (as advised by the doctor).

Additionally, he highlights how taking oral corticosteroids for a long time can cause the adrenal glands to produce less natural steroid hormones, which is why he says doctors may reduce the dosage gradually – gradually because if the dosage is reduced too quickly, one’s adrenal glands may not have time to recover and one may experience fatigue, body aches and light-headedness.

Dr Shah on the other hand advises people to get a bone scan (DEXA) for osteoporosis risk evaluation, regular sugar check and periodic HbA1c check for diabetes so as to assess the risk of long term steroid use. In addition, she recommends maintaining a healthy balanced diet and regular exercise to reduce the risk of developing side effects.


What can be the side effects of long term steroid use?

“Systemic steroids are associated with significant adverse effects,” says Dr Sunil Kumar.

Systemic steroids are synthetic or artificial derivatives of the natural steroid, cortisol, produced by the adrenal glands.

“Prolonged use of these medications may raise your risk of diabetes, cataracts, osteoporosis, or bone density loss or infection. Steroids can also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues,” the doctor explains.

Dr. Shah further shares some of the possible side effects of long term steroid use:

– Osteoporosis
– Obesity
– Thinning of skin
– Hair loss
– Gastritis and gastric ulcers
– Diabetes- Glaucoma and early cataract
– Increased susceptability to infections
– Mood changes and obstructive sleep apnoea (OSA)
– Avascula necrosis, which is the death of bone tissues due to a lack of blood supply

FAQs

1. What are steroids?
   According to the UK National Health Services (NHS), steroids, also called corticosteroids, are anti-inflammatory medicines used to treat a range of conditions.
2. When are steroids prescribed?
   Steroids are used to treat people with health problems such as allergies, asthma, eczema, inflammatory bowel disease, arthritis and more.
3. Are there possible side effects to steroids?
   Side effects of steroid use include heartburn, mood swings, increased appetite, increased risk of infections, poor bone health, diabetes and more.
4. How to reduce side effects from long term steroid use?
   You can ask your doctors to lower the dosage gradually. Make sure you take calcium and vitamin D supplements to prevent bone damage from prolonged steroid use. Eat healthy and indulge in regular exercise.