Corticosteroids (cortisone): action and side effects
A few months ago, my doctor decided it was time I should take a cortisone-based medication. On the one hand, I know this medication is supposed to alleviate my asthma. On the other hand, I can’t help wondering about the side effects attributed to corticosteroids. If I understood the side effects, I might more readily accept taking this medication. What is cortisone’s function in the body? Why are there so many side effects?
Cortisone is a molecule that belongs to the large family of corticosteroids. It is a natural hormone that is produced by the two adrenal glands located above the kidneys. This hormone is essential to body function; without it, survival isn’t possible. Cortisone plays many roles: it helps metabolize sugars, fats and proteins; it influences the circulation of water, sodium and potassium in the body; and it is a strong anti-inflammatory. This last attribute justifies its use as medication, not only in cystic fibrosis, but also in many other diseases.
Cortisone can be used alone as a medication, but most often synthetic corticosteroids like prednisone are used because they have fewer side effects such as water retention and loss of potassium. All corticosteroids can cause side effects that are directly related to dosage and length of treatment. The main side effects are weight gain with fat distributed around the face and torso, acne, a tendency to bruise easily, a decrease in children’s growth rate, elevated blood sugar, bone loss and substance dependence. When large doses are taken for extended periods, the body stops producing its own cortisone and becomes dependent on the corticosteroids it is given.
Cystic fibrosis causes severe bronchopulmonary inflammation, and corticosteroids are part of therapeutic treatment. Clinical studies have shown the efficiency of corticosteroid pills in slowing lung deterioration in a population of children with cystic fibrosis, but in these studies it was found that the medication produced unacceptable side effects. This medication is used only in very specific situations, the main ones being bronchial hyperactivity (asthma) associated with cystic fibrosis, and an allergy to a fungus known as Aspergillus (allergic bronchopulmonary aspergillosis). In these cases, we always try to administer the smallest effective dose for the shortest possible time. Under certain circumstances, such as mild asthma, we administer a corticosteroid spray to prevent absorption into the blood stream, thus preventing all the above-mentioned side effects. You have to rinse your throat and mouth after each use, however, to avoid the proliferation of the benign fungus, Candida albicans.
Much research is being done on alternative anti-inflammatory treatments that have fewer side effects than cortisone and its derivatives. Although these treatments may be easier to tolerate, they are not as potent as corticosteroids.