The symptoms you describe are well-recognised complications of steroid treatments. Weight gain, bruising more easily and facial hair are also increasingly common among women as they reach middle age. However, it's likely that in your case they're linked to the inhaled steroids.
Inhaled steroids are a lot safer than oral steroids (taken as tablets) because they act topically, on the inner surface of the lungs, and have only a weak systemic action on the rest of the body.
Side effects are usually limited to the other tissues exposed to the steroids as they pass from the mouth into the lungs, and so include oral thrush or candida, and changes in voice because of the weakening laryngeal muscles. However, there's no doubt that in some cases generalised problems occur, especially when inhalers are used in high dose for prolonged periods, as some steroid passes from the lungs into the blood stream and around the body.
Cushing's syndrome
Steroid medication can have several effects on the body. In particular they may interfere with control of natural steroid production by the pituitary and adrenal glands.
Studies have shown that doses above 1,000mcgm a day may cause some suppression of the body's own steroid production. Above 2,000mcgm a day is associated with thinning of the skin, glucose intolerance (a diabetes-like syndrome), psychiatric disturbance in rare cases and cataract formation with long-term therapy. Some inhaled steroids have been associated with a reduction in bone density (that is, osteoporosis).
These symptoms are collectively known as Cushing's syndrome. Other symptoms of Cushing's include:
- Wasting of tissues, including skin and muscles
- Purple lines or striae on the abdomen
- Water retention
- More rounded or 'moon-shaped' face
- Fat deposits on the neck and head (known rather unkindly as a buffalo hump)
- Predisposition to infection
- Poor wound healing
- Loss of periods
Using inhalers effectively
These symptoms are reversible, so the main goal is to reduce the dose of steroids you're getting, if possible.
However, for some asthmatics, steroids are life saving. It's essential that you don't stop taking your medication suddenly.
Talk to your doctor or respiratory consultant. They may suggest trying to slowly reduce the dose, or switching to another type of inhaled steroid as sometimes people are less sensitive to different brands.
There are also a few ways to make your inhaling technique more effective and avoiding getting too high a dose of steroid. These include using a spacer device (less medication is deposited in the mouth and swallowed, while more of the dose reaches the lungs).
This article was last medically reviewed by Dr Trisha Macnair in July 2008
