Responding to the reader
What are the long-term effects of steroid medications?
Story by Laura Ly/Image by iStock
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Anabolic steroids help increase muscle mass and are used to enhance performance in sports, but they can result in a wide range of side effects such as “roid rage”, liver damage, and infertility. Another class of steroids, known as corticosteroids, is used in a wide variety of medical conditions, but does this class cause similar side effects to anabolic steroids? What are the long-term implications of corticosteroid treatments? We asked Dr. Richard Leigh, a researcher at the University of Calgary who studies the use of corticosteroids in asthma.
There are two groups of corticosteroids: mineralocorticoids and glucocorticoids. Mineralocorticoids are part of the system that maintains the salt and water balance in the body, and glucocorticoids help modulate metabolism and the immune system. An important glucocorticoid is cortisol, which is released by the adrenal glands in response to stress or injury. Cortisol functions primarily to increase blood sugar; to suppress the immune system to decrease inflammation; and to aid in fat, protein, and carbohydrate metabolism. Various synthetic forms of cortisol are used to treat a variety of inflammatory conditions, including lung diseases (such as asthma), inflammatory bowel disease (IBD), rheumatoid arthritis, and various skin conditions. Corticosteroids can be taken orally, inhaled, injected, or applied to the skin.
Sometimes the body is unable to regulate the amount of cortisol it produces. Cushing’s syndrome occurs when the body produces too much cortisol, and adrenal insufficiency disorders such as Addison’s disease occur when the adrenal glands fail to produce enough cortisol. People with adrenal insufficiency disorders take corticosteroids to replace the cortisol the body is unable to produce naturally.
Short-term steroid use is used to treat conditions such as gout, certain skin conditions, and inflammatory eye infections. Often in diseases like IBD and asthma, steroid treatments are long term and can be lifelong in adrenal insufficiency disorders. “Side effects tend to be associated with long-term steroid use. Generally, if you use steroids for a short period of time—maximum 14 days—your side-effect profile is significantly less,” notes Dr. Leigh.
“Possible side effects of long-term steroid use include osteoporosis, hypertension, acne, bruising, diabetes, mood alterations, and alterations in sleep patterns,” says Dr. Leigh. A common side effect is weight gain, which is closely linked to alterations in mood. “Corticosteroids can cause altered, happy moods in people. This happiness typically results in an increased appetite. People eat more when they feel happy and tend to gain weight.”
Asthmatics who receive steroids in the form of inhalers can also suffer oral thrush, a side effect that is unique for inhaled corticosteroids. Oral thrush is a yeast infection that occurs in the throat. “We advise people who use inhalers to rinse their mouth out and brush their teeth to minimize this side effect,” notes Dr. Leigh.
The likelihood of side effects is related to the frequency and dosage of a person’s medication. For example, inhalers provide substantially less cortisol per dose when compared to pills. Dr. Leigh explains, “Inhalers provide roughly 125–250 micrograms of glucocorticoid per inhalation; in comparison, pills are 25–50 milligrams—a hundredfold difference. Inhalers direct glucocorticoids instantly and directly into the airways where it needs to work. Pills need to go through the bloodstream and the liver to be metabolized.” As a result, the smaller dose administered by inhalers tends to minimize side effects for asthmatic patients.
To prevent side effects such as osteoporosis and diabetes, patients are monitored throughout the course of treatment to determine their risks for these diseases. “Doctors will perform a bone scan before they start patients on oral corticosteroids. If patients show a high risk of osteoporosis, they’ll be prescribed a biphosphonate medication to minimize bone loss. Doctors should also suggest being on vitamin D and calcium supplementation, and encourage ongoing weight-bearing exercise,” says Dr. Leigh. Patients with a high risk of diabetes are encouraged to monitor their blood sugar levels carefully and maintain a healthy diet.
Dr. Leigh, a specialist in respiratory medicine and part of the University of Calgary’s Airway Inflammation Research Group, studies airway inflammation as it occurs in asthma and chronic obstructive pulmonary disease. He wants to identify alternative non-steroid treatment options and find treatment strategies that have minimal side effects.
His research may help to eliminate side effects altogether. “We’re trying to see if we can use steroids in combination with other medications to get the same anti-inflammatory effect with a lesser quantity of steroids. My research is focused on identifying the optimal dose that controls asthma without causing side effects.”