Corticosteroids are among the most powerful anti-inflammatory agents in medicine — they save lives in asthma attacks and calm severe inflammation, but with long-term, uncontrolled use they can do a great deal of harm. The key lies in the form (inhaled, topical or systemic) and in the duration of treatment. Here is what you need to know — informative, not a substitute for your doctor.
What they are and how they work
They are synthetic derivatives of cortisol, the natural hormone of the adrenal glands. They reduce inflammation and calm an overactive immune system. It is precisely their strength that also explains the side effects: the more the dose reaches the whole body (systemically), the higher the risk.
Inhaled — for asthma and COPD
Budesonide, fluticasone and beclometasone act locally, at the level of the lung, with little passage into the blood. They are the foundation of asthma control treatment, according to the GINA guidelines. Typical side effect: oral candidiasis (thrush) and hoarseness — these are prevented by rinsing your mouth after each puff. They are not "rescue" medication: for an attack you use the rescue bronchodilator.
Topical — for the skin
Hydrocortisone (weak), mometasone (medium) or clobetasol (very potent) are applied to lesions of eczema, dermatitis, psoriasis. Potency and duration must be respected: prolonged application over large areas or on the face thins the skin and can cause stretch marks. The practical rule: the lowest potency that works, for the shortest period.
Systemic — oral or injectable
Prednisone, dexamethasone and methylprednisolone treat severe inflammation (autoimmune flares, severe allergic reactions, some respiratory diseases). They are very effective, but with prolonged courses the following appear: rising blood sugar and blood pressure, water retention, osteoporosis, insomnia, weight gain, lowered immunity, and over time a "cushingoid" appearance. Very important: they are not stopped abruptly after longer courses — the body must be "accustomed" through gradual reduction, otherwise adrenal insufficiency occurs.
What is up to you
Stick to the prescribed form and dose, rinse your mouth with inhaled forms, do not extend a topical corticosteroid on your own and do not abruptly stop an oral treatment. Tell your doctor if you have diabetes, high blood pressure or osteoporosis. For up-to-date prices at nearby pharmacies, use the HartaFarmacii search.
- ANMDMR — SmPC for inhaled, topical and systemic corticosteroids
- GINA — the global guideline for asthma management
- EMA — safety information on corticosteroids