So what's the deal with steroids?
You may hear the word "steroids" and have visions of body builder's or even worse, all those bad things that can happen by taking "steroids" by mouth. One thing I hear every day is "Doctor Carr is my kid going to be short because he is taking steroids?" or "I don't want to give my kid steroids for her asthma because they are not safe."
Well here is the deal. First, the kind of steroids that we use in Allergy is called corticosteroids. They do not build muscle those are called anabolic steroids and are related to testosterone, the male hormone. Corticosteroids are used to treat inflammation and they work very well.
When they were first developed they were marketed as an oral medicine or injectable medicine. They worked very good to control inflammation when given in this way, especially when given in higher doses. The problem with this is when you take something by mouth it is absorbed into the blood stream and affects the whole body. Taken for a long period of time, especially in high doses, this method of taking steroids can have a lot of side effects. They can affect the immune system, lead to thinning of the bone, affect the eyes, and the blood vessels as well as many other organs.
To get around these problems topical corticosteroids were developed. It makes sense if you think about it. When you have asthma, or nasal congestion you don't need a medicine that affects your kidneys, bones, and other organs. All you need is something for your lungs or your nose. When you or your child has an itchy skin rash, rubbing a small amount of cortisone (a corticosteroid) onto the rash is not only soothing but does not affect the rest of the body. So the same goes for asthma (inflammation of the lungs) or allergic rhinitis (inflammation of the lining of the nose), treating with a nose spray or asthma inhaler is targeted, topical therapy, much like the cream for the skin rash. This way, those severe side affects of oral corticosteroids are avoided and patients feel better.
So back to those questions, here is what I say:
"Doctor Carr is my kid going to be short because he is taking steroids"
Well there are been some studies that have shown a small reduction in the rate of growth in kids that have asthma and are taking inhaled steroids. However, there are some very important points that need to be made. When a reduction of the growth velocity was noted it was ONLY in the first year that the medications were taken, and these kids will reach their normal adult height. This decreased rate of growth was around 5 to 10 millimeters (that is pretty small). Asthma, on the other hand, is a CHRONIC inflammatory disease of the lungs. Over 500,000 people are hospitalized every year from asthma and 4,000 a year die from asthma. That mean eleven people a day will die from asthma. In addition, if this chronic inflammatory disease is not treated the children are much more likely to have "stunted" growth as the body is using all of this nutrition to fight off inflammation, rather than using it for growth. When the corticosteroid is given topically as an inhaler or nasal spray it is given is very small amounts, in micrograms rather than milligrams. These are small amounts and targeted only to the affected areas. In reality, these are some of the safest medications that doctors may prescribe.
"I don't want to give my kid steroids for her asthma because they are not safe."
Well as I said above, these are some of the safest medicines that doctors prescribe, and uncontrolled asthma leads to 11 deaths a day. Now I can't predict the future and there is risk in everything that we do everyday so let's make sure that your child needs a corticosteroid. If you have a question, see an allergy specialist and make sure that the corticosteroids are the way to go. As I said above, everything we do in life has a risk. For instance, every time you put your child in the car there is a chance of a fatal car accident, yet we drive almost every day. Why? It is because the benefit far out weighs the risk. That is how it goes with corticosteroids and asthma or allergic rhinitis. The benefits far out weigh the risk.
So remember, these types of medications have been around for a very long time. They have been proven, in many studies, to be safe and effective in the treatment of allergic diseases for many years. Finally, taking a daily topical steroid every day for a year can be far less than taking a oral steroid for 5 days.