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Corticosteroids ("steroids") reduce airway and systemic inflammation and are used both as daily inhaled preventers and as short oral courses in flare-ups. Biologic therapies are newer, targeted injectable treatments for severe asthma and related conditions. This page covers corticosteroids, with the points that matter for physiotherapy such as steroid myopathy and infection risk. Biologic therapies have their own page.
Corticosteroids dampen airway and systemic inflammation and are used across cardiorespiratory disease — inhaled for maintenance in asthma and selected COPD,1,2 and oral (or intravenous) in short courses for exacerbations and in longer courses for conditions such as interstitial lung disease and sarcoidosis. For physiotherapy the important considerations are the side effects of sustained use — muscle weakness (including a proximal myopathy that affects exercise), reduced bone density, raised blood sugar and skin fragility — which shape exercise prescription and fall-prevention, and the need to rinse the mouth after inhaled steroids. The table below summarises the corticosteroids commonly used and their implications.
Corticosteroids in cardiorespiratory disease
| Corticosteroid | Typical context | Typical dose | Duration | Implications for physiotherapy |
|---|---|---|---|---|
| Prednisolone (oral) | Acute asthma exacerbation | 37.5–50 mg daily | 5–10 days | Mood and sleep effects common. Hyperglycaemia |
| Prednisolone (oral) | COPD exacerbation | 30–50 mg daily | 5 days | Repeated courses contribute to osteoporosis, myopathy, cataract |
| Prednisolone (oral) | IPF acute exacerbation, organising pneumonia, ICI pneumonitis | 0.5–1 mg/kg/day | Variable, weeks-to-months | Steroid-induced myopathy — adapt exercise prescription. Hyperglycaemia |
| Prednisolone (oral) | Sarcoidosis (active extra-pulmonary or progressive pulmonary) | 20–40 mg daily then taper | Months | Bone protection essential if duration >3 months |
| Prednisolone (oral) | CTD-ILD, vasculitis | 0.5–1 mg/kg/day then taper | Months, often combined with steroid-sparing agent | Consider DEXA, bone protection, falls-risk assessment |
| Hydrocortisone (IV) | Acute severe asthma | 100 mg qid IV | Switch to oral once stabilised | Common in ED and ward settings |
| Methylprednisolone (IV) | Acute exacerbation IPF, severe ICI pneumonitis, transplant rejection | 0.5–1 g IV daily ×3 ("pulse") | 3-day pulse then maintenance | Hyperglycaemia, mood changes, infection risk |
| Dexamethasone | COVID-19 (oxygen-requiring), cerebral oedema, palliative | 6 mg daily PO or IV | 10 days (COVID); variable | Stronger glucocorticoid potency than prednisolone (~7×) |
| Inhaled corticosteroids | Asthma, COPD (with continuing exacerbations or eosinophilia) | See Table 4 | Long-term | Oral candidiasis (rinse mouth after dose), dysphonia |
For the inhaled corticosteroid decision in COPD, GOLD 2026 lowers the exacerbation threshold to a single moderate exacerbation — one requiring antibiotics and/or oral corticosteroids — rather than the earlier two-or-more rule, and frames management around disease activity rather than airflow limitation alone.2 These are guidelines, not rules — a clinician should still apply clinical judgement to the individual patient.
Common side effects affecting physiotherapy practice: proximal myopathy, hyperglycaemia, weight gain and fluid retention, insomnia, mood changes, osteoporosis with fracture risk. Patients on prednisolone ≥7.5 mg/day for ≥3 months warrant bone protection, DEXA scanning, and falls-risk assessment.3
References & evidence base
- Global Initiative for Asthma. Global strategy for asthma management and prevention: 2026 update. GINA; 2026. Available at: ginasthma.org
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of COPD: 2026 report. GOLD; 2026. Available at: goldcopd.org
- Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2026.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use. For drug-specific detail, including full product information, consult MedsInfo.
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