The British National Formulary (BNF) now recommends that when patients use a high dose steroid inhaler to control their asthma or COPD, a small amount of the steroid may be absorbed into the blood stream.
When this happens, the body may reduce its own production of corticosteroid. This is the body's main stress hormone so it is particularly important during periods of injury or illness.
Then, if a patient stops their high dose steroid inhaler suddenly, e.g. if they suffer an injury or illness, there is a small chance of the body not having enough corticosteroid to cope with the injury or illness.
As a result of this recommendation, we have been advised to provide all patients taking a high dose steroid inhaler with a Steroid Treatment Card (please see the photograph above), which they should carry with them at all times.
Please click here to see which steroid inhaler doses count as a high dose. Your community pharmacist can help you identify if you should carry a Steroid Treatment Card & they can provide you with one if necessary.
Some challenges for The Corner Surgery in adopting this guidance are:
- Our computer system does not allow us to identify all patients using high dose steroid inhalers automatically;
- A patient's dose of inhaled steroid often changes over time - indeed some patients are advised to increase & reduce the dose themselves in response to their symptoms - so our computer records may not be accurate;
- We do not have an accurate record of patients who have already been provided with a Steroid Treatment Card.
Therefore, we will be identifying patients opportunistically during their asthma or COPD annual reviews & by using computer searches, & directing patients/ carers to this webpage for further information.
If you prefer to carry a Steroid Treatment Card irrespective of whether your steroid inhaler dose is high or not, that is absolutely fine - they are available to collect at your community pharmacy & at the Surgery.
We recognise that this change in national guidance may cause some patients to worry but we must stress that any risk from stopping a high dose steroid inhaler is theoretical & very small.
By comparison, steroid inhalers have been used safely for many years and they are a vital treatment for many patients with asthma or COPD - the benefits are huge so please do not stop one without taking medical advice.
If you have any questions about this matter, please discuss it with our practice nurse at your next asthma or COPD review. It may be safe for some patients to wean their steroid inhaler dose if they have a particular concern.