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Column originally published Jan 29, 1997

Prednisone Is A Very Safe And Effective Medicine When Used Carefully

Question: Our son was recently admitted to the hospital because of an asthmatic attack. Our doctor started him on prednisone as well as inhalers. I heard that prednisone is a steroid and I read someone in England had died because of taking steroids. I am really worried about our son taking this medicine, although his asthma has gotten better. Do you think I should be concerned about prednisone?


You probably read the story of a British couple who came to North America recently and warned about the harmful effects of steroids. Their young daughter died several years ago from severe chickenpox infection after taking oral steroids for several months. Your son’s situation was very different and I don’t think that you have to worry.

Many people probably have never heard of steroids until someone they know was given this medicine by a physician. Our body actually produces large amounts of natural steroids every day. These natural steroids are very important in maintaining everyday functions of the body. Most of the steroids are produced in two little glands sitting above the kidneys. These are called adrenal glands.

Several decades ago, scientists modified the most common natural steroids and produced two much more powerful artificial steroids called prednisone and prednisolone. These are the steroids that doctors use to treat medical conditions like asthma, arthritis, colitis, lupus, nephrotic syndrome and severe allergy, as well as leukemia in children. It is important to point out that prednisone and prednisolone are very different from the steroids that athletes use for body-building.

When prednisone is given to a child with asthma, it is usually used for one to two weeks only. The side effects are often mild, if any. Prednisone has a very bitter taste and many parents have to be resourceful to get their children to swallow it. Some children can become irritable while on prednisone. There may even be a slight increase of appetite which disappears when prednisone is stopped. For a short course like this, it doesn’t affect the child’s immune system, and regular immunization can be given without delay.

The situation is very different if the child has a more serious illness that requires prednisone for a longer time. The most obvious side effects are excessive appetite and weight gain. The cheeks can become much bigger than usual, and there is increased fat throughout the body, a condition that is called Cushingnoid effect. This problem usually disappears gradually after prednisone is discontinued. There is also increase in body hair over many parts of the body, and teenagers may find troublesome pimples on their face and chest.

Other common side effects of prednisone include high blood pressure, diabetes, and stunting of growth. Oral steroids in high doses can also suppress the immune system if taken for more than two to four weeks. Serious bacterial infections and chickenpox can spread throughout the body. Unless treated properly, these children can die from overwhelming infection. Any child who develops infection while on high dose oral steroids should be examined by a physician immediately and treated appropriately.

If one takes prednisone for one to two weeks because of an asthma attack, it is safe to stop the medicine suddenly at the end of the course. However, if prednisone is taken at a high dose for more than a few weeks, it is important to gradually reduce the medicine before stopping. This is because the body recognizes the presence of prednisone and will produce less of the natural steroids. If prednisone is stopped suddenly, the adrenal glands cannot increase their production of natural steroids right away. This can result in dangerously low steroid level in the body.

I hope that I have explained to you and other parents about prednisone. This is really a very safe medicine when it is used carefully. Just like any other medicine, we always have to balance the benefits and side effects. It is a good idea to discuss with your physician whether there are alternatives to oral steroids, and the length of time that is required. If your child gets sick while taking steroids, you should contact your doctor immediately.