Using steroids to treat respiratory infections risky
“Steroid Shots and the Culture of Instant Gratification,” an editorial published on Oct. 8 in JAMA Otolaryngology-Head & Neck Surgery online, highlights a frequent failure to practice evidence-based medicine.
I was surprised to learn that doctors often prescribe oral or injected corticosteroids for acute respiratory tract infections like sore throat, sinusitis, bronchitis and the common cold even though evidence of benefit is sorely lacking and risks of the drugs are widely known.
Yet a recent analysis of nearly 10 million outpatient medical visits in the United States showed that nearly 12% of patients with acute respiratory infections were prescribed oral or injected steroids, and this dubious practice is on the rise.
The analysis found that prescriptions for steroids like prednisone to treat acute respiratory ailments nearly doubled from 2007 to 2016.
Although steroids can be invaluable, even lifesaving, in treating asthma, chronic pulmonary disease and preventing transplant rejection, their misuse can result in a treatment that is worse than the disease.
The editorial writer, Dr. Edward D. McCoul, otolaryngologist at the Ochsner Clinic Foundation, described a scenario that is apparently replicated hundreds of thousands of times a year in the United States among patients given steroid injections for acute respiratory infections: “Within moments of receiving the intramuscular injection your congestion wanes, the headache vanishes, and your energy level skyrockets.”
Sure, McCoul told me, you feel better, at least temporarily – steroids, after all, counter inflammation and have a euphoric, energizing effect. But at what price?
Dr. Beth I. Wallace at Michigan Medicine and Dr. Akbar K. Waljee of the VA Ann Arbor Healthcare System, writing in the Annals of Internal Medicine, listed three serious risks that can follow as few as three days of treatment with corticosteroids taken orally by relatively young, otherwise healthy patients: gastrointestinal bleeding, sepsis and heart failure.
A Danish study found an elevated risk of diabetes and osteoporosis among patients who had received one or more steroid shots a year for three or more years to treat allergic rhinitis, another use of steroids lacking evidence of benefit.
Dr. Evan L. Dvorin, internist at the Ochsner Health System and Dr. Mark H. Ebell of the University of Georgia, writing in American Family Physician, added several other side effects linked to steroids: low blood sugar, elevated blood pressure, mood and sleep disturbances, fracture and blood clots.