Here's How Systemic Steroids Work

This past winter I found myself on steroids again. They work great for fixing asthma. But, the side effects are miserable. I felt so miserable the last time I was on them that I said, “I’m not going back on those again.” Yet, when my doctor recommended them this time around, I was a good patient.

I have to admit, that despite the side effects, they are good for ending asthma episodes. So, I figured this was a good time for a review on how steroids work.

Exposed to triggers

All asthmatics have some degree of underlying airway inflammation. When exposed to your asthma triggers (like the common virus), this inflammation may get worse. This is what causes asthma symptoms.

Inflammation is good to some extent. It’s your immune systems way of trapping unwanted pathogens. You inhale a virus. That virus attacks your airway cells. Your immune system responds by releasing chemicals. These chemicals tell airway wall cells to increase their permeability. This causes them to release some of their fluid.

This results in increased airway wall inflammation. It makes them red and inflamed Specialized cells (goblet cells) lining airways are irritated by this and secrete extra mucus. Nerve cells are irritated causing pain-like symptoms, such as chest tightness and itchiness. With a cold, this also happens in your upper airway, causing a runny nose, itchy nose, nasal drainage, sneezing, etc.

This whole process is meant to trap, kill, and remove the virus. It’s meant to keep you healthy. If you have an infection, it’s meant to get you feeling better.

But, in our case, this response is exaggerated. Most asthmatics have some degree of “always there” airway inflammation. A daily dose of the inhaled corticosteroid in Advair usually keeps this in check for me. But, sometimes, like when I caught the flu last week, it’s not enough. My asthma gets worse. And, I see my doctor.

He orders a prednisone pack.

It's like a catch 22

Being the good patient I am, I oblige. I pick up the prescription from Meijers. I take the first dose. And then I reap the rewards of better breathing. But I also suffer the side effects.

Systemic corticosteroids like Methylprednisolone mimic natural cortisol. It’s a hormone secreted by the adrenal cortex (It’s a part of your adrenal glands. They sit on top of your kidneys). Cortisol

Helps you respond to stress. It also has other jobs, such as regulating the intake of carbs.

For our purposes, a major part of what it does is suppress the immune response that causes inflammation.  It blocks or prevents the immune system from releasing those specialized chemicals that cause inflammation.

So, in this way, corticosteroids suppress your immune response. It’s good in that it reduces airway inflammation to make breathing easier. It is very effective at ending asthma attacks. It’s also very effective for treating other inflammatory diseases, like arthritis. So, an added bonus is those body aches and pains are gone for the time being.

But, there are side effects. As noted, the adrenal cortex produces cortisol. You are at risk of these side effects when you take in more of this hormone than what is naturally produced. So, you take 24 mg of Methylprednisone on the first day. This is a nice dose. Your body notices this, and so it stops producing cortisol.

This is why you have to be weaned off systemic corticosteroids. If you immediately stop, you will probably experience some harsh withdrawal symptoms, such as nausea and vomiting. I have never experienced these symptoms, as I’m a good patient.

But, just being on synthetic steroids causes side effects. These side effects are different from one person to the next. For you, your side effects might be different than mine. We are all different. Our bodies are all different. So, we all respond to these medications in different ways.

Me? I feel bloated. I feel like my skin is stretched taut over my swollen tissues. My stomach feels bloated, even though I’ve eaten very little today. And I’ve eaten very little, despite the unending, unsatiated hunger.

That’s what they do to me.

I have never experienced this before, but this time they have also given me an insatiable thirst. It seems that no matter how much I drink I am still thirsty. I am told by my nursing friends that this is because steroids also increase your sugar. This is why you get thirsty and hungry.

So, this is how steroids affect this asthmatic. They certainly are nice for the breathing. They are nice in that they take away body aches and pains. But, nasty side effects are a good incentive to take them only as instructed, and avoid them unless pertinent.

Have you taken systemic steroids for your asthma? How have they impacted you?


By providing your email address, you are agreeing to our privacy policy.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Join the conversation

or create an account to comment.

Community Poll

Has asthma changed your exercise routine?