Steroid management

Steroid management

Statement 4.5

Steroid treatment should be managed in accordance with guidelines and audited on an ongoing basis, with clear guidance to primary care.

Why is it important?

Some types of steroids, known as glucocorticoids, can be very effective for healing inflamed parts of the bowel. But they are not recommended for long-term treatment. What’s more, clinicians and patients together need to consider various concerns when it comes to steroid dependence, associated side effects and withdrawal. Successful treatment depends on careful management and monitoring.

It’s important to give patients clear information about steroids. This should include pros, cons and possible alternatives. For example, exclusive enteral nutrition should be an option for managing a flare of Crohn’s Disease. Ideally, this information should be offered in a variety of formats - written, audio-visual and web-based, and in language that the patient is able to understand.

Clinicians too need to take several factors into account. These include: ways to spare and minimise any dependency on steroids; managing physical and mental side effects; ensuring necessary health checks are undertaken; and having auditing processes in place to ensure that patients are not prescribed courses for more than 3 months. Vitamin D and calcium supplements should also be routinely prescribed along with steroids.

Through regular auditing1, we can identify inappropriate prescribing or management. For example, it can help identify ‘hidden’ prescriptions, where a prescription may have been given in primary care but not communicated to the specialist team. (This opens up a wider opportunity to improve communication between teams and access to specialist advice.)

In addition to good clinical practice, it’s also vital to have clear and effective processes for sharing and communicating relevant information about a patient’s treatment and care.

It took me a while to reduce my steroid dose as the symptoms kept coming back and I had to return to the starting dose. But each time I was able to get telephone advice from my IBD nurse.

Lucy, age 45, diagnosed with Crohn’s Disease in 2013