Thousands of asthmatics in Ireland over-relying on 'toxic' steroid tablets

Just like oral corticosteroids pills, inhalers contain steroids, but at much lower concentrations. Stock picture

Thousands of asthmatics in Ireland are over-relying on “toxic” steroid tablets instead of a care plan and inhalers, the Asthma Society has found.

These concentrated tablets are usually used as a short-term treatment but new research shows some asthmatics are using them far more frequently.

The study also found however that children’s use of these tablets fell by almost a third (31%) from 2018 to 2020.

A survey of prescriptions filled in Irish pharmacies between 2018 and 2020 found that, out of an estimated 380,000 asthmatics, 4,212 collected these tablets at least three months in a row. Another 14,474 collected them at least three times during a 12-month period, and more than 101,997 (26%) collected them at least once.

Differences between pills and inhalers

Dr Marcus Butler, the medical director at the Asthma Society of Ireland said there is a significant difference between these tablets and asthma inhalers. The inhalers also contain steroids, but at a much lower concentration and the substance is delivered direct to the lungs.

“Over a quarter of asthmatics in Ireland had to get a prescription for the most potent treatment used,” he said.

These tablets are a necessary evil. Cumulatively, they take a toll on a patient’s health, it’s short-term important gain but with long-term harms. 

Dr Butler, a respiratory consultant at St Vincent's University Hospital, said as few as four courses can lead to osteoporosis in some people.

He urged any patients regularly taking these tablets, known as oral corticosteroids, to discuss asthma care with their GP as treatment tweaks could address the problem.

“There are over 4,000 people on these maintenance steroids who need to be on something like a biologic drug to reduce that dependency on this toxic long-term medication,” he said. Biologic drugs are often prescribed for severe asthmatics, but carry an annual price tag of around €15,000.

Asthma Society of Ireland CEO Sarah O’Connor says their helpline nurses frequently hear from 'inhaler-hesitant' people who hear negative stories about steroids, and mistakenly think this applies to inhalers. File picture

Sarah O’Connor, CEO of the Asthma Society said patients can contact their helpline for free to discuss asthma action plans. This can be taken to a GP for further discussion. She said the society is “particularly concerned” about the people repeatedly collecting prescriptions for these tablets.

It is also important for asthmatics to understand the difference between these tablets and ordinary steroid inhalers, she said.

The helpline nurses frequently hear from “inhaler-hesitant” people who have heard bad stories about steroid tablets and mistakenly think this applies to inhalers, she explained.

However, Dr Butler said the research indicates some people including children saw their asthma ease during the lockdowns.

“The thing that was encouraging is we saw a greater uptake in asthma maintenance, so people taking inhalers, and that was associated with a reduction overall in the use of steroids,” he said. 

• To learn more, visit the helpline page on the Asthma Society of Ireland website.