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Steroid phobia: myth vs. fact

By Andy Nish, MD, FAAAAI

The word “steroid” likely brings some negative thoughts to mind. Sometimes concern over the use of steroids, and some myths surrounding them, can hamper treatment for medical conditions. Steroids used to treat diseases have both benefits and potential side effects. The goal of this article is to give you information to help separate myth from fact.

Myth: All steroids are the same.

Fact: There are different types of steroids. Anabolic steroids, frequently publicized in the media, are basically male hormones. This type of steroid, when used by athletes, is meant to build muscle. While having a legitimate medical use, they can cause significant side effects when used to improve athletic performance.

The steroids commonly used to treat inflammation in diseases such as asthma and hay fever are called corticosteroids, because the body produces them naturally in the cortex region of the adrenal gland. Corticosteroids medications are manufactured synthetically.

It is also important to note that corticosteroids medications given by different routes will have different potential risks for side effects. Typically, corticosteroids given for a long period of time by mouth or injection will have more potential for side effects than corticosteroids given by nasal or inhaled routes, which are dispensed in relatively tiny doses. Long courses of steroids by mouth cannot be stopped abruptly. They should be tapered off over a period of time.

Myth: Steroids will stunt your growth.

Fact: For the overwhelming majority of children who are on inhaled corticosteroids for asthma and/or nasal steroids for rhinitis, or nasal disease, height will not be affected. There is some evidence that children on inhaled corticosteroids may actually have some decrease in growth velocity in the first year of treatment. However, other studies of large numbers of children have shown that with years of inhaled corticosteroid use, expected final adult height was attained.

Steroids, typically given in large doses by mouth, over a long period of time and during childhood, may actually be associated with a decrease in final attained height. Examples of well-known individuals, such as actor Gary Coleman, who was on long-term steroids by mouth for kidney disease, may come to mind.

We also know that asthma that is not well controlled regardless of whether the child is taking a corticosteroid—can be associated with decreased growth. Children with asthma, on inhaled steroids or not, need to have their growth closely monitored. A recent panel of asthma experts felt strongly enough about their benefits to recommend inhaled corticosteroids as the treatment of choice for asthma in even very young children.

Myth: Steroids hurt your immune system.

Fact: It requires fairly high doses of steroids by mouth for prolonged periods of time to limit the body’s ability to fight infection. Even then the immune system gets back to normal once the patient is off steroids. One potentially concerning situation is when a child who has not had chickenpox or been vaccinated is exposed to chickenpox while on oral steroids. In this case, the child’s physician should be informed immediately. Inhaled steroids carry a similar warning, although the actual risk is likely very small. Children in general, but particularly children with asthma, should routinely receive the chickenpox vaccine.

Myth: Steroids will damage your bones.

Fact: Expert panels of scientists have studied this question, particularly in regard to osteoporosis, or thinning of the bones. For children, the experts conclude that there is no evidence that inhaled corticosteroids decrease bone.

For adults, inhaled corticosteroids in general are not associated with a decrease in bone, although adults on high doses of inhaled corticosteroids for many years could be at some risk. For all ages it is important to maintain adequate intake of vitamin D and calcium to keep bones strong. For adults, particularly women on inhaled corticosteroids who have a family history of osteoporosis, screening tests may be considered. Courses of oral steroids, particularly if given for a long period of time, can very rarely be associated with a type of bone disease called avascular necrosis.

Myth: Steroids will hurt your eyes.

Fact: In general, inhaled corticosteroids are thought not to adversely affect the eyes. There may be some increased risk of cataracts in older adults who are on high doses of inhaled steroids. There may also be a small risk of glaucoma associated with the use of inhaled corticosteroids, but this is uncertain.

For long courses of steroids by mouth, the risk of eye problems is much higher. It is recommended that older adults on high doses of inhaled corticosteroids and people of any age on long courses (months or years) of oral steroids see their ophthalmologist at least once a year.

Myth: Steroids will affect fertility.

Fact: There is no evidence that corticosteroids affect a woman’s ability to become pregnant or limit fertility in men.

Hopefully these quick facts will help you determine steroid myths from facts. Corticosteroids are some of the most effective medicines an allergist/immunologist has to treat allergic diseases, and their benefits typically far outweigh their risks.

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