Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Asthma - Management
What are the adverse effects of continuous or frequent use of oral corticosteroids and how can they be managed?

  • The risk and severity of adverse effects with oral corticosteroids increase with the dose and the duration of treatment. People receiving long-term oral corticosteroids (more than 3 months) or those needing frequent courses of an oral corticosteroid (three to four per year) are at risk of systemic adverse effects.
  • Systemic adverse effects include osteoporosis, hypertension, diabetes, hypothalamic–pituitary–adrenal axis suppression, weight gain, cataracts, glaucoma, skin-thinning, easy bruising, and muscle weakness.
  • Aim to prevent, minimize, or quickly detect adverse effects of long-term corticosteroids. General and lifestyle recommendations to minimize adverse effects include the following:
    • Encourage adequate dietary calcium intake and good nutrition.
    • Maintain normal body weight where possible.
    • Advise on smoking cessation.
    • Advise on moderate alcohol consumption.
    • Encourage physical exercise within the limits imposed by the underlying disease.
    • Perform a falls risk assessment, where appropriate, and advise those at increased risk of fractures from falling.
  • Monitor, prevent, and treat the systemic adverse effects of continuous or frequent courses of oral corticosteroids:
    • Blood pressure: monitor regularly and treat if necessary.
    • Diabetes mellitus: screen regularly and treat if necessary.
    • Osteoporosis: see the CKS topic on Osteoporosis - preventing steroid-induced for details on when to prescribe prophylactic bisphosphonate therapy.
    • Growth suppression: record height of children regularly and accurately.
    • Cataracts: screen children periodically through community optometric services.
  • Children who frequently use courses of oral corticosteroids should have regular checks for signs of adrenal suppression. Refer to a paediatrician who can arrange Synacthen® testing, where appropriate.
  • Document the person's history of chickenpox (fatal disseminated chickenpox may occur in non-immune people). Advise all people without a history of chickenpox who are taking systemic prednisolone to avoid close contact with people who have chickenpox or shingles, and to seek urgent medical advice if they are exposed.

[GINA, 2006; BNF 53, 2007; SIGN and BTS, 2009]

© NHS Institute for Innovation and Improvement