Steroids prescribed to 25% of asthma patients despite side-effects

One quarter of asthma patients were prescribed steroids last year, despite their potentially harmful side-effects when used long-term, new research indicates.

While the overall number of people requiring steroid tablets to treat their asthma fell during the pandemic in 2020, there was a big increase in the minority of patients requiring repeat prescriptions.

The Asthma Society of Ireland, which commissioned the research, described as alarming the increase in use among this small but vulnerable group.

The society estimates there are about 380,000 people affected by asthma, almost 27 per cent of whom filled a prescription for oral corticosteroids from a pharmacy last year.

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Some 82,500 people with asthma collected up to two steroid prescriptions, an indication that they may not have their asthma under control.

More than 31,000 people bought asthma inhalers in 2020 who hadn’t in the previous two years, according to the society’s research.

Children

Overall steroid use for asthma fell 21 per cent last year, while use among children dropped 31 per cent between 2018 and 2020.

However, one-fifth of those prescribed steroids are using them at least three times a year, with consequent risk of side-effects.

More than 4,000 people collected a steroid prescription three or more months in a row, a level of use the Asthma Society says is a cause of particular concern.

Oral corticosteroids are an anti-inflammatory medicine prescribed for a wide range of conditions. They can be associated with significant harmful side-effects as a result of long-term use. Even occasional short courses of OCS can be associated with increased health risks, the charity points out.

A continual need to prescribe steroid tablets for a patient with mild to moderate asthma should signify the need for review by a patient’s GP, it says. The person with asthma may not be taking their “controller” inhaler every day or they may not be using it properly.

Isolating

Dr Marcus Butler, respiratory consultant at St Vincent's University Hospital attributed the drop in steroid use last year to the fact that people were isolating at home, wearing masks and washing hands more frequently during the Covid-19 pandemic.

“Unfortunately, prolonged use of this medication has severe health implications. In the short term, side-effects can include sleep disturbance, mood changes, appetite increase and hyperglycaemia, while depression, diabetes, hypertension and adrenal suppression are more of an issue in the longer term.

“It’s important to remember that steroids are the last tool we should reach for in our toolbox, and a focus on improving better asthma control and management are preferred.”