Steroids And Asthma
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"Steroids" are a family of chemicals normally made within the body. They serve as hormones —chemical signals that help to regulate the body's growth and function. Some steroid hormones, like testosterone, stimulate formation of protein and growth of muscle. Competitive athletes have been known to take illicitly derivatives of these "body-building" steroids in large amounts to improve their athletic performance. A very different group of steroid hormones are the corticosteroids, steroid hormones made in the cortex (hence, "cortico-") of the adrenal glands, which sit adjacent to the kidneys. Corticosteroid hormones have many different affects on body function, including influences on how we use our energy stores (fat, protein, and sugar) and how we adjust the salt and water content of our body.
Early in this century it was discovered that corticosteroid hormones, if purified and taken in large amounts as a medicine, have powerful anti-inflammatory effects. Ever since this discovery, corticosteroids have been used to treat a great variety of diseases where inflammation (not infection and not cancer) is the major problem—from arthritis to psoriasis to asthma. When you and your doctor talk about steroids to treat your asthma, it is these anti-inflammatory corticosteroids about which you are speaking.
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Steroids Swallowed or Steroids Inhaled
To treat the inflammation of asthma within the bronchial tubes, steroids can be taken in tablet or liquid form or by inhalation. Occasionally, steroids are given by injection or—in hospitalized persons —directly into the veins (intravenous infusion). Taken as tablets, liquid, injection, or intravenous infusion, the steroid medication travels in the blood and is carried throughout the body, including to the bronchial tubes. Used in this way, steroids have their most powerful effects— both for the good (relieving asthmatic symptoms) and for the bad (undesirable side effects). On the other hand, modern steroid medications inhaled on the bronchial tubes from pressurized canisters act directly on these tubes; almost no medication is carried into the bloodstream. Although not as powerful in their immediate effects, steroids by inhalation are better suited for long-term use in the treatment of inflamed bronchial tubes because they are free of major undesirable side effects.
Examples of steroids in tablet form are prednisone (Brand name: Deltasone) and prednisolone (Brand name: Medrol). Examples of steroids by inhalation are triamcinolone (Brand name: Azmacort); beclomethasone (Brand names: Vanceril, Qvar, and Beclovent); flunisolide (Brand names: Aerobid and Aerobid-M); fluticasone (Brand name: Flovent); and budesonide (Brand name Pulmicort).
More information about the inhaled steroids is available in a separate pamphlet prepared by the Partners Asthma Center, entitled, Asthma and Inhaled Steroids. The remainder of this pamphlet focuses on the use of steroids in tablet or liquid form.
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A Short Course of Steroids
Steroids taken in tablet or liquid form ("oral steroids") are usually prescribed for asthma that has become difficult to control by any other means; they are the most effective treatment available for a severe "attack" of asthma. Most often, they are prescribed for a short period of time: a short course may be as brief as 3-4 days or as long as 2-3 weeks. They are stopped when the asthma has gotten better and other treatments suffice to keep it under control. Longer periods of treatment and continuous treatment with oral steroids are generally avoided except for the most difficult-to-control asthma because of the undesirable side effects that often develop with prolonged oral steroid treatment
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Variable Doses and Schedules
The dose of oral steroids will vary with the severity of the asthma and an individual's sensitivity to the medication. As a rough guide, we consider less than 20 milligrams (abbreviated "mg") of prednisone a low dose, 20 to 30 mg a moderate dose, and 40 to 60 mg a high dose of oral steroids. When rapid relief from an asthma attack is needed, a high dose will often be recommended initially, followed by a gradual reduction in dose on successive days until the oral steroids are stopped: a "steroid taper." However, when a short course of oral steroids is used, it is not always necessary to taper the dose; a high dose can be safely stopped abruptly (for instance, 40 mg of prednisone taken each day for 3 days, then stopped). There is no single schedule of oral steroid dosing that is right for all asthma attacks in all patients. Your doctor will try to recommend the best schedule for you at that particular time, and he/she may need to adjust it over the ensuing days according to how you and your asthma are responding to it. Most often, we recommend taking the tablets altogether in the morning. Sometimes the steroid dose is divided up during the day and on occasion even given once daily in the evening.
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Effects of a Short Steroid Course
The beneficial effects of oral steroids are usually evident within several hours. Breathing becomes easier and wheezing, cough, mucus production, and chest tightness all gradually lessen. Other allergic diseases, such eczema and nasal congestion and drip, are also likely to be helped by the anti-inflammatory action of the oral steroids. Many people also find that oral steroids, independent of their effect on breathing, give a powerful boost of energy—for a short while.
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Undesirable Side Effecs of a Short Steroid Course
Undesirable side effects of oral steroids are common, even during a short course. Any individual person may experience none, some, or all of these side effects, which generally go away quickly when the medication is stopped. These side effects include: stomach irritation ("indigestion"), fluid retention causing a sense of bloating, hunger, sleeplessness, blurry vision, short temper, and difficulty concentrating. Women may have their menstrual cycle become irregular for a brief while and may develop a vaginal yeast infection. Rare complications include loss of a sense of reality (psychosis), triggering the onset of diabetes, and injury to the bone in a joint (aseptic necrosis of a bone). To avoid some of these side effects, take your oral steroids with food and, if necessary, antacids (for example, Maalox or Mylanta) to minimize stomach upset; avoid excessive salt intake (to minimize fluid retention and bloating); and avoid heavy alcohol consumption (a risk factor for developing aseptic necrosis of a bone). Over-the-counter medications are available to treat vaginal yeast infections, including Monistat and Gyne-lotrimin.
When the steroid dose is being tapered or stopped, one may experience a different set of side effects. These include: a flu-like stiffness or aching in the joints, lack of energy and appetite, and sadness or teariness that seems inappropriate to one's situation. Bear with them; these side effects will go away in a short while.
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Undesirable Side Effects of Prolonged Use of Oral Steroids
If taken for a long time (months to years), daily oral steroids, especially in moderate to high doses, can cause many harmful side effects. These complications of long-term use include cataracts of the eyes, thinning of the bones (osteoporosis), weakness of the muscles (myopathy), fragile skin with a tendency to bruise easily, hair loss, facial hair growth in women, puffy cheeks, a fatty bulge at the base of the back of the neck, and weight gain. Long-term steroid use also predisposes to certain types of unusual infections, to the development of high blood pressure and diabetes, and to shrinkage of the glands that normally make corticosteroid hormones in the body, the adrenal glands. This latter effect makes it dangerous to stop suddenly oral steroids if you have taken them regularly in moderate to high doses for more than about 3 to 4 weeks. You might then become sick from a lack of the normal amounts of corticosteroids in your bloodstream, a condition called "adrenal insufficiency." Also, should you undergo major surgery or suffer a severe medical illness, your adrenal glands might be unable to produce the extra amounts of corticosteroid hormone usually made under these circumstances. To prevent this from happening, your doctor would routinely provide you with supplemental steroids either by tablet or by intravenous infusion.
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There is overwhelming evidence which shows that creatine supplementation does cause an increase in the amount of creatine phosphate in muscles. Harris et al (1992) conducted a study examining creatine content in the quadriceps femoris muscle in 17 subjects after supplementation of 5 g of creative monohydrate 4-6 times a day for two days. The results found a significant increase in the total creatine level in all subjects but the results were especially noticeable in those with the lowest muscle creatine store at the start of the study. To determine whether exercise could affect the amount of creatine absorbed by muscles, some of the participants followed a unique training program. During supplementation, they pedaled a bicycle ergometer for one hour each day while using only one leg to supply the pedaling force. With supplementation, the unexercised legs increased their creatine levels by about 25 percent, but the exercised legs increased their creatine levels by 37 percent. It is hypothesized that exercise increases the flow of blood to the muscles or changes the rate at which muscles absorb creative from the blood, thus improving the creatine loading effect. Another study conducted by Febbraio replicated the results obtained by Harris.
Several studies also show that creatine supplementation does cause an increase in muscle strength. Earnest et al (1995) conducted a study investigating the influence of creatine monohydrate supplementation on muscular power and strength in 10 experienced weight trained male subjects. Three series of high intensity, anaerobic type muscular workouts were used. The first series consisted of three consecutive 30 second Wingate bike tests, followed by five minuets of rest. Peak anaerobic power was defined as the greatest power achieved in a given five second work interval. Anaerobic work was defined as the total amount of work performed in a 30 second period. The second series used a one repetition maximum (lRM) free weight bench press as a test of muscular strength. The third series utilized complete lifting repetitions at 70% of the bench press IRM until fatigue. Fatigue was defined as the inability to complete one lifting repetition or the inability to maintain a lifting cadence of one second eccentric and one second concentric (lifting and lowering the weight). Total lifting volume was calculated as 70% of pre-test IRM multiplied by the number of complete lifting repetitions. Subjects received either a glucose placebo or creatine monohydrate supplement in a double blind fashion. (After 14 days of supplementation, each subject was re-tested on the Wingate bike tests. Re-testing for the weight lifting trials was done after 28 days of supplementation.
Within the creatine group, total anaerobic work from the Wingate tests was significantly higher during all post-test trials. The increases were 13% for series one, 18% for series two and 18% for series three. No changes were noted in the placebo group. Greater total anaerobic work resulted from the creatine subject's ability to achieve and maintain higher levels of anaerobic power consistently over- each five second time interval. Bench press IRM increased 6% in the creatine group. Total lifting volume was significantly higher within the creatine group, whether expressed in absolute terms (26%) or relative terms (29%). Increases in the total lifting volume were associated with the ability of the creatine group to perform 26% more lifting repetitions. The authors conclude that the ability of the creatine group to perform a greater total lifting volume demonstrates the effectiveness of creatine as an ergogenic aid.
In Hultman's study (cited in Anderson, 1974) these results were replicated. Each day, creatine was given in six separate doses of five grams a day. During the six-day period, five other Estonian runners of comparable ability received a glucose placebo instead. All runners were unaware of the actual composition of their supplements. Before and after the six-day supplementation, the athletes ran four 300-meter and (on a separate day) four 1000-meter intervals, with three minutes of rest between the 300-meter intervals and four minutes of rest between the 1000-meter intervals. Improvement on the final 300-meter interval (from pre-to-post supplementation) was more than twice as great for creatine users, and improvement was more than three times as great for creatine supplements in the final 1000-meter interval. Total time to run all four 1000-meter intervals improved from 770 to 757 seconds after creatine supplementation. In comparison, the placebo group actually slowed from 774 to 775 seconds.
In Hultman's study (cited by Anderson, 1994) creatine supplementation was very important during the last interval of each workout. Creatine supplementers doubled their advantage during the final 300-meter interval and tripled their advantage in the closing 1000-meter sprint. This supports Hultman's hypothesis that creatine is likely to be most helpful when lactic acid levels are highest and fatigue is greatest. Hultman thus feels that creatine serves as a buffer lowering lactic acid muscle burn and delaying fatigue, thus allowing an athlete to perform longer workouts.
In contrast, Balsom at al (1993) investigated the influence of creatine supplementation on endurance exercise performance in the form of a 6 km run and showed that creatine supplementation does not enhance performance or increase peak oxygen uptake during prolonged continuous exercise. There was actually decreased performance in the creatine supplementation group, which may be attributed to the participants weight gain.
In support of Balsam et al (1993), Febbraio et al (1995) conclude that creatine supplementation "may not increase performance during exercise where a significant proportion of energy is derived form aerobic metabolism." This aerobic metabolism occurs during more prolonged, sustained exercise as opposed to anaerobic metabolism which occurs during fast, nonsustained muscle contractions. It is therefore more likely that if creatine supplementation has an effect it will only be seen during brief, anaerobic exercise such as sprinting or weight lifting.
As you may or may not know, creatine monohydrate will not fully dissolve in liquid. That's why you always get that gritty sand at the bottom of the glass. Look at it this way, if it falls like sand to the bottom of your glass what does it do in your stomach? Maybe that explains why so many complain of stomach discomfort when using regular creatine monohydrate.
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Creatine works by enhancing muscle cell hydration. It is very important to consume adequate fluids while taking creatine to see best results. A good rule of thumb is to drink an EXTRA 16 to 20 ounces of liquid for every 5 grams of creatine you take.
During your Loading Phase you should be drinking an EXTRA 64 to 80 ounces of liquid than you normally drink. During the maintenance phase you should drink an EXTRA 32 to 40 ounces.
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