Local pharmacist urges caution over misuse and overuse of steroid medicines |06 March 2021

• “Overuse and misuse of steroids can cause a masking of symptoms which might otherwise point to a larger underlying medical condition”

Pharmacist, owner and founder of Panacea Healthcare, Tanja Allcorn, has expressed her concern about patients, parents and carers in Seychelles visiting the pharmacy to purchase steroid nebules for nebulizers in order to self-medicate.

In the following interview, she explains why this is a problem, and shares her knowledge about the importance of seeking the advice of a qualified healthcare professional before purchasing steroid medicines at pharmacies.      

Seychelles NATION: Can you explain to us what steroids and steroid nebules are?

Tanja Allcorn: Steroids are – in layman’s terms – a group of hormones that our body produces to fight inflammation. There are various forms, both natural and man-made. Our bodies produce them at various times as required, and we can prescribe them at various stages of illness to suppress inflammatory processes that have gone awry.

Instances where steroids might be prescribed include asthma, rheumatoid arthritis, inflammatory bowel disease, various autoimmune (where the immune system attacks its own body) diseases, acute allergic reactions, to name but a few.

Steroid nebules, specifically, are inhalable steroids dosettes which are used in nebulizers. These are indeed prescribed on a chronic (long-term) basis in patients who have chronic breathing conditions such as asthma.

An inhaled steroid is the most efficient way of delivering the medication directly to the area that needs it, namely the lungs and breathing tubes. The side effects from inhaled steroids – compared to swallowed or injected steroids – are minimal, and their benefits when used correctly, far outweigh any risks.

Seychelles NATION: You gave some examples of circumstances where steroids might be prescribed. Can you tell us more about these?

Tanja Allcorn: There are many chronic inflammatory conditions that require long-term, low-dose steroid treatment; asthma is the most common one. The disease is kept controlled with a low dose of (inhaled, in this case) steroids by calming down the inflammatory process, and thus allowing the affected organs to function normally.

In asthma, for example, chronic use of inhaled steroids reduces the occurrence of acute asthma attacks which are medical emergencies. A well-controlled asthmatic will be on a small daily dose of inhaled steroid (known as a “preventer”), which cuts their requirement for their “reliever” medication – most commonly salbutamol known by trade names such as Ventolinâ or Asthalinâ - to an ideal standard of fewer than 3 times in a week.

Inhaled steroids are also used chronically in other breathing conditions such as Chronic Obstructive Pulmonary Disease (COPD). Other chronic inflammatory conditions such as Inflammatory Bowel Disease also require long-term use of low dose oral (swallowed) steroids.

Then you have instances of acute (sudden) inflammatory diseases such as an asthmatic crisis, inflammatory bronchitis, acute allergic reactions etc where larger, short-term steroid courses are given. This is done in a controlled manner, so that the body adapts and reacts as it should.

Seychelles NATION: Why is it a concern if people are self-medicating with steroid nebules or any other medication containing steroids?

Tanja Allcorn: ALL steroid-containing medication should be used ONLY as prescribed by a doctor, or other suitably qualified health care professional. Over-use and misuse of steroids can cause a masking of symptoms which might otherwise point to a larger underlying medical condition.

This is important because let’s say someone has – in an extreme case – lung cancer. They think it is “bronchitis” so they go to various pharmacies and buy steroids (and/or antibiotics, which is a subject for another day) and feel better.

Under the surface, however, something more sinister is brewing. But they continue to self-medicate, and with the passing of time, the underlying issue gets worse and worse until they finally do go and see a doctor, by which time something that might have been easily treatable at the start is now a major issue.

While this is already a precarious situation for an adult, imagine now a small infant. The parent was at one point prescribed inhaled steroids for the baby because it was the right thing in that particular situation. Now the parent goes into a private pharmacy and buys more because to the parent, the symptoms appear to be the same. In the parent’s mind, this is what worked last time, it should work this time, right?

Going to buy it from a private pharmacy saves a lot of time, and it is easier. But, in this new scenario, no one has listened to the child’s breathing. No one has checked whether the child’s lungs are clear. No one has checked for any signs of infection. So, the parent goes home, nebulises the infant with the steroids (+/- other medication they asked for or were given).

In the worst case outcome, the symptoms subside for a while. Then one day the baby is in severe distress. Parent rushes the infant to the hospital. The doctor confirms pneumonia. This might NOT have happened if self-medication on this level had not been facilitated, but the parent or patient had been asked more questions, educated about the risks of self-medication, and referred to a doctor.

Seychelles NATION: Are medications with steroids supposed to be given out with a doctor's prescription only?

Tanja Allcorn: As a rule, yes. Steroid inhalers (“Preventers”) for asthmatics who have well-controlled asthma and a clear understanding of their disease state, can be issued over the counter. This frees up clinic resources and can be done safely.

Certain steroid creams and ointments can be given out over the counter. Again, in this case it is extremely important that the patient is educated about how to safely and effectively use the steroid creams. I have seen so many cases over the years, of misuse of steroid creams (a country favourite is the infamous Betnovateâ) leading to chronic problems such as the thinning of the skin, skin discoloration, and a worsening of underlying fungal or bacterial skin conditions.

Seychelles NATION: Would you like to share any advice to the local population?

Tanja Allcorn: ALWAYS ask for advice from a qualified healthcare professional. Always follow your healthcare provider’s advice. Use medications containing steroids exactly as directed, and if you have any questions, ask!

Please do not assume you know what’s best because “it worked before”. Every medical situation requires assessment. A reliable healthcare professional will ASK you questions. They will LISTEN to your responses. They will ANALYSE the information. They will then CONSIDER the options, and will then make an INFORMED decision as to the BEST approach for your treatment.

And, while I have your attention, may I also implore you - NEVER go and buy antibiotics over the counter. The fall out we are seeing from the misuse of antibiotics is wreaking havoc in the world. Antibiotic resistance is a major catastrophe throughout the world, and we all have to play our part to stop it getting worse.

For further information, contact Panacea Healthcare:

-                       Address: PO Box 4083, Anse Royale, Mahe

-                       Telephone: 2 753 771 (Mobile & WhatsApp) and 4 371 024 (Pharmacy)

F.P.