Asthma can cause wheezing, chest pain, and shortness of breath. Steroid medications are a common, effective treatment, but they can cause some side effects.

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More than 25 million Americans live with asthma, an inflammatory disease that affects your airways. Severe asthma can obstruct your breathing to the point where you need immediate medical attention.

Steroid medications, also called corticosteroids, are often prescribed to treat asthma. Steroids effectively reduce asthma symptoms in most people, but they don’t work for everyone. Plus, some steroid prescriptions can cause serious side effects.

Learn about the benefits and risks of steroid medications for asthma below.

When you have an asthma attack, your immune system reacts very strongly to a perceived invader. The lining of your airways begins to swell, and mucus fills your lungs and windpipe. These issues make it hard for air to pass through.

Steroids treat this inflammation in two ways. They discourage your body from producing more inflammatory chemicals, and they also encourage your body to produce more anti-inflammatory chemicals.

Your body naturally makes its own steroids, but steroid medications contain manufactured chemicals that bind more efficiently to the necessary cell receptors. That’s why steroid medications can provide quicker relief than waiting for your body’s own systems to kick in.

Steroid medications may come in an inhaler, oral medication, or injection.

Inhaled corticosteroids

Inhaled corticosteroids are medications you breathe in. They may come as a powder you put in an inhaler or a liquid capsule you inhale via a nebulizer. Examples include:

These are generally the first line of treatment. They work well for most mild or moderate cases of asthma, and they pose a lower risk of side effects.

Side effects from low-dose inhaled steroids are generally mild and reversible. Around half of people taking them report hoarseness (dysphonia) since steroids can temporarily weaken the muscles in your larynx.

Higher doses can cause additional issues, such as:

Do steroids stunt growth?

Researchers have long debated whether steroids can stunt growth in children. Children taking low or medium doses do grow at a slightly slower pace than their peers.

That said, asthma itself also slows growth, so it’s hard to tell whether this delay comes from the medication or the disease. Most kids who take inhaled steroids will eventually reach their expected adult height, just at a slightly later time.

High doses of inhaled steroids may cause a slight reduction in height though. An older review from 2015 found that taking these steroids for longer than 12 months seemed to reduce final adult height by about 1 centimeter, or 0.39 inches.

A more recent review from 2019 suggests some steroids may affect growth more than others. Specifically, beclomethasone and budesonide may have more of an impact on growth in children with persistent asthma. That said, the authors of this review emphasize the need for more research.

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Oral corticosteroids

Oral corticosteroids may come in tablet, pill, or liquid form. Examples include hydrocortisone (Cortef) and prednisone.

A doctor or healthcare professional may prescribe these medications for severe asthma that doesn’t respond to inhaled steroids.

Due to the risk of side effects, doctors typically prescribe only a short round of oral steroids for emergency relief. If you have frequent asthma attacks, though, a doctor may prescribe these as a daily medication.

These medications may cause both short-term side effects — which means they last less than 30 days — and long-term side effects.

Short-term side effects include:

Long-term side effects include:

Due to these side effects, most doctors will usually only prescribe oral steroids if your asthma symptoms don’t respond to inhaled steroids.

Injections and infusions

Severe asthma cases can send you to the emergency room, where your care team may recommend an intravenous (IV) infusion of steroids to restore your breathing.

Once the doctors have stabilized you enough to go home, they may give you a corticosteroid shot to prevent another attack. Like oral steroids, these shots are quite powerful and pose a high risk of similar side effects.

Some people may prefer getting a shot because they only have to get it once, when they have an asthma attack, as opposed to taking a pill each day. A 2018 study found injected and oral steroids were equally effective at preventing another severe attack.

Around 5% to 10% of people with asthma have steroid resistance. This means that even high doses of steroids don’t improve your symptoms much. If your lung strength improves less than 15% after 2 weeks, you may have steroid-resistant asthma.

Several factors can contribute to steroid resistance:

  • Nonallergic asthma: Steroids are good at targeting Th2 cells, which control your body’s response to allergens. They don’t target other immune cells as effectively.
  • Genetic mutations: Genetic differences can make it harder for steroids to bind to your cells. Mutations can also skew your baseline levels of inflammation.
  • Cigarette smoking: Cigarettes can decrease your body’s sensitivity to steroids, although you can reverse this effect if you stop smoking.
  • Viral or bacterial infections: Research has linked respiratory syncytial virus (RSV), Haemophilus influenzae, and rhinovirus to steroid resistance.

A bout of coronavirus disease 2019 (COVID-19) can worsen your asthma symptoms. In 2020, a U.K. survey asked 4,500 people with asthma about their pandemic experiences.

Among respondents who had gotten COVID-19, 39.2% said they had a harder time managing their asthma symptoms, and 54.3% said they increased their inhaler use.

Your asthma medication could help protect you from severe disease. Some research suggests inhaled steroids may reduce the expression of your ACE-2 receptors. These receptors are the main gateways severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses to invade your cells. So, “closing” these gates may better protect your body from the virus.

Doctors may also prescribe steroid infusions if you’re hospitalized with COVID-19 and need breathing assistance. Some evidence suggests dexamethasone can improve survival rates for people who are on ventilators or taking supplemental oxygen. Dexamethasone may also shorten the amount of time you spend on life support.

A doctor may prescribe prednisone, methylprednisolone, or hydrocortisone if you can’t take dexamethasone.

Many people with asthma take bronchodilators. These medications relax the muscles around your airways, allowing them to dilate so more air can pass through. Dilated airways also provide more space for mucus to move, which helps you cough it out of your lungs.

While bronchodilators can ease your breathing, they don’t address the physical swelling of your airway walls. If you still find it difficult to get enough air, a doctor may recommend combining bronchodilators with anti-inflammatory medications such as:

  • Biologics: These are shots or infusions containing manufactured proteins. They target a particular cell or protein in your immune system to prevent inflammation.
  • Leukotriene modifiers: These pills target leukotrienes, inflammatory chemicals that contract your windpipe. This kind of medication can prevent your body from making leukotrienes or keep leukotrienes from binding to the muscles around your airways.
  • Cromolyn sodium: You can take this medication via a nebulizer. It stabilizes your mast cells and prevents them from releasing various inflammatory chemicals.

When do I need steroids?

If you have asthma symptoms more than 2 days a week, or your symptoms become severe enough to interfere with everyday life, a doctor may prescribe inhaler steroids. If these doesn’t improve your symptoms, you may need to try oral or injected steroids.

Do asthma inhalers contain steroids?

Your asthma inhaler may contain steroids, bronchodilators, or a mix of the two. You can receive steroids through a dry powder inhaler, soft mist inhaler, or a metered-dose inhaler.

Are steroid inhalers suitable for children?

Children of all ages can safely take inhaled steroids. But if you have an infant or toddler younger than 5 years old, you may find it easier to use a nebulizer. Unlike inhalers, nebulizers don’t require active participation.

Can pregnant people take steroids?

Inhaled steroids are generally considered safe to use during pregnancy and don’t affect fetal growth. Oral steroids can cause fetal anomalies though. Doctors generally don’t prescribe them unless your asthma is severe enough to endanger your pregnancy.

What’s an alternative to steroids for asthma?

The most common alternative to steroid asthma medication is a bronchodilator. Other options include biologics, leukotriene modifiers, and cromolyn sodium.

Steroids help treat asthma by reducing swelling and mucus production. Inhaled steroids can treat asthma in most peoploe, but severe symptoms may require oral steroids.

If you’re considering steroid treatment for your asthma, talk with a doctor about your priorities, concerns, and expectations. They can help you find the right medication to maximize your recovery and minimize your health risks.

Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.