A new study found that using oral or inhaled glucocorticoids, a type of steroid used to reduce inflammation in asthma and other autoimmune conditions, may be associated with detrimental changes in the brain’s white matter.
This study, led by Merel van der Meulen, a postdoctoral fellow at Leiden University Medical Center in the Netherlands, and published on Tuesday in the journal BMJ Open, “shows that both systemic and inhaled glucocorticoids are associated with an apparently widespread reduction in white matter integrity.”
The tissue known as “white matter” is what connects brain cells to the rest of the nervous system. The brain’s capacity to process information, pay attention, and recall can be slowed by having less white matter. Lower white matter volumes have also been linked to psychiatric conditions such anxiety, depression, and irritability.
Thomas Ritz, a psychology professor at Southern Methodist University who has studied the effects of steroids on people with asthma and who was not involved in the study, said that the new study is especially compelling as it demonstrates how medication use affects white matter, which is necessary for neurons to connect with one another.
But according to neuroimmunologist Dr. Avindra Nath, clinical director of the National Institute of Neurological Disorders and Stroke, who was also not involved in the study, “there’s no reason for alarm,” The brain does shrink when patients are given steroids, but it returns when the steroids are stopped, doctors have long known, according to Nath.
These “could be temporary effects,” he said, referring to the brain’s capacity to restructure its connections, functions, and structure. They don’t have to be permanent, necessarily. White matter is capable of self-repair.
Due to their widespread use in a variety of illnesses, specialists suggest that glucocorticoids are among the most often prescribed anti-inflammatory drugs.
Allergies, chronic obstructive pulmonary disease (COPD), Crohn’s disease and other forms of inflammatory bowel disease, eczema and other skin conditions, lupus, tendinitis, multiple sclerosis, osteoarthritis, and rheumatoid arthritis can all be treated with oral and inhaled glucocorticoids in addition to treating asthma.
However, quick-relief inhalers used to halt an asthma attack should not be mistaken with glucocorticoid inhalers. Albuterol, levalbuterol, and pirbuterol are examples of non-steroid drugs found in quick-relief inhalers that relax the lungs’ muscles and can quickly open airways. Inhaled corticosteroids are indicated for longer-term management of inflammatory diseases; they are ineffective in crises.
Long-term use of oral glucocorticoids has been linked to structural changes in the brain and the shrinking of certain parts of the brain, as well as mental health problems like anxiety, depression, confusion, and feeling lost. Additionally, research has indicated that asthma sufferers are more likely than non-asthmatics to experience cognitive and memory decline in later life.
However, many earlier studies have been limited in scope and occasionally inconclusive, according to specialists.
The new research made use of information collected by the UK BioBank, a huge biomedical research facility that monitored the health of 500,000 people living in the United Kingdom between the years 2006 and 2010. From this database, researchers were able to find 222 people who used oral glucocorticoids and 557 people who used inhaled glucocorticoids but had never been diagnosed with a neurological, hormonal, or mental health disorder.
These individuals were evaluated for cognitive and mental health and had a diffusion MRI of the brain. Researchers extracted this information from the database and compared the MRI and cognitive results to those of nearly 24,000 individuals who did not use steroids.
Researchers extracted this information from the database and compared the MRI and cognitive results to those of nearly 24,000 individuals who did not use steroids.
According to the study’s authors, this is the largest study to date examining the relationship between glucocorticoid use and brain anatomy. It is also the first to look into these relationships in people who use inhaled glucocorticoids.
The study discovered that those who consistently use oral steroids for extended periods of time have the most severe white matter damage. Chronic oral steroid users evaluated slower in terms of mental processing speed than non-users. Additionally, apathy, despair, fatigue, and restlessness were more common among oral steroid users than in non-users.
The study discovered that inhaling steroids had the slightest effect on white matter.
According to pulmonologist Dr. Raj Dasgupta, an assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California, who was not involved in the study, it is consistent with what medical professionals observe in clinical practice.
“We don’t see side effects as often with the inhaled form of glucocorticoids,” he added. “And of course, mainstay of therapy for allergies and asthma is always going to be avoiding the triggers and making lifestyle modifications.”
According to Dasgupta, due to the numerous adverse effects of steroid use that can also affect health, particularly brain health, pulmonologists and rheumatologists are cautious about prescribing the smallest dose of steroids required to control symptoms.
“As a clinician, the minute you start a person on these medications, you’re immediately thinking, ‘How do I safely take that person off in a timely fashion?’ Steroids cause weight gain, and weight gain is always going to be a risk for developing diabetes and high blood pressure,d” Dasgupta added as cited by CNN.
He continued, “When you give steroids to people with diabetes, their blood sugar can go up. When you take steroids acutely, you could definitely have insomnia and trouble sleeping, and when you’re on long-term steroids, it puts you at a high risk for infections because they are an immunosuppressant.”
More study is required
New research had limitations. For starters, Ritz said, it was unable to calculate the dosage of steroids or monitor adherence.
“We know that only about 50% of patients with asthma take their medication as prescribed, and potential overreporting of intake is also an issue,” Ritz added.
“You should take your inhaled corticosteroids, which reduce the inflammation locally, as regularly as possible, albeit at the lowest possible dose that allows you to control you asthma.
“This study gives us another reason to keep the dosages low,” he continued.
The inability to distinguish between users of infusions and those who use steroid tablets is another limitation, according to the study’s authors.
The results of the study mainly confirm “what we know for a long time in asthma management: Take as few systemic (oral) corticosteroids as possible, as long as you are not a patient with severe asthma. Stick to inhaled steroids and discuss with your treating physician plans to step down medication regimens during good times,” according to Ritz.
Nath remarked, “It’s a very well done study. But the findings demand another study to be done to see how long these effects last and how they can be reversed.”
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