Corticosteroids, or steroids, are powerful medications that reduce inflammation throughout the body. These synthetic drugs resemble cortisol, a hormone naturally produced by your adrenal glands. Medical steroids differ from anabolic steroids (misused for muscle building) and are crucial for managing various health conditions, including coughs. This article explores how steroids alleviate coughs, the conditions they treat, administration methods, and considerations regarding side effects and safe usage.
How Steroids Reduce Cough
Corticosteroids primarily alleviate cough by reducing inflammation in the airways. When the respiratory system experiences inflammation from infection or irritants, airways swell, become irritated, and produce excess mucus. This inflammatory response triggers the cough reflex as the body attempts to clear the airways.
Steroids suppress inflammatory cells and decrease pro-inflammatory chemicals. This calms the immune system’s overreaction, reducing swelling and irritation in the nose, throat, and lungs. By counteracting these processes, corticosteroids open airways and decrease mucus, diminishing the urge to cough.
Cough Conditions Treated with Steroids
Steroids are prescribed for coughs stemming from underlying inflammatory conditions, not common colds or viruses. Coughs associated with asthma often respond well, as asthma involves chronic airway inflammation. Daily inhaled steroids manage this, while oral steroids may be used during acute flare-ups to quickly reduce symptoms like coughing and shortness of breath.
Chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, also involves significant airway inflammation, making steroids a relevant treatment option for coughs and exacerbations. Severe bronchitis, a lower respiratory tract infection causing inflamed lungs and airways, can lead to coughs benefiting from steroid intervention. Post-viral cough, lingering for weeks after respiratory illness, may improve with inhaled corticosteroids if inflammation contributes. In younger children, croup, a viral infection narrowing upper airways and causing a “barky” cough, is often treated with steroids to reduce laryngeal swelling.
Forms of Steroid Administration
Steroids can be administered in several ways, depending on the cough condition and its severity. Inhaled corticosteroids (ICS) are common, delivered directly to the lungs via devices like metered-dose inhalers (MDIs), dry powder inhalers (DPIs), or nebulizers. These forms, such as fluticasone or budesonide, are prescribed for long-term management of conditions like asthma and COPD, providing localized anti-inflammatory effects with less systemic absorption.
Oral corticosteroids, like prednisone or prednisolone, are taken by mouth as pills or syrups, providing a systemic effect by reducing inflammation throughout the body. These are often used for short “bursts” to manage severe or acute coughs, such as severe asthma exacerbations or acute bronchitis. In hospital settings, intravenous (IV) steroids may be administered for very severe respiratory emergencies, offering rapid anti-inflammatory action, typically transitioning to oral forms as symptoms improve. While local administration generally leads to fewer side effects, even these forms can have some systemic absorption with repeated exposure.
Potential Side Effects and Safe Usage
While effective, steroids come with potential side effects varying by dosage, duration, and administration method. Inhaled corticosteroids can cause localized side effects like oral thrush (a yeast infection) and hoarseness. Rinsing the mouth after using an inhaler can help reduce these issues.
Systemic oral or intravenous steroids carry a higher risk of widespread side effects, especially with prolonged use or higher doses. Short-term effects include insomnia, increased appetite and weight gain, stomach irritation, fluid retention, and mood changes. Longer-term use of systemic steroids may lead to more serious concerns such as bone thinning (osteoporosis), increased blood sugar levels (worsening or triggering diabetes), high blood pressure, and an increased risk of infections due to immune system suppression. Medical supervision is necessary when using steroids for a cough, and dosages should be strictly adhered to. Abruptly stopping long-term steroid therapy can lead to withdrawal symptoms and an imbalance of natural hormones, so a gradual reduction under medical guidance is often advised.