Taking Steroids for Aspergillosis? What You Need to Know

Last reviewed: 9 October 2026

Different types of steroid treatment

Corticosteroids can be given in several ways. Although they belong to the same family of medicines, their effects and risks depend on the medicine, dose, duration of treatment and how it is administered.

Oral steroids affect the whole body. Inhaled and nasal steroids act mainly where they are delivered, but some medicine can still enter the bloodstream. This becomes particularly important when certain antifungal medicines are taken at the same time.

What is prednisolone?

Prednisolone belongs to a group of medicines called glucocorticoids, commonly known as corticosteroids or simply steroids.

These medicines reduce inflammation and suppress parts of the immune response.

Prednisolone may be prescribed for:

• Asthma and severe asthma exacerbations.
• Allergic bronchopulmonary aspergillosis (ABPA).
• Rheumatoid arthritis and other autoimmune diseases.
• Inflammatory bowel disease.
• Other inflammatory or allergic conditions.

In aspergillosis care, corticosteroids are mainly used when inflammation or an allergic immune response is causing illness.

For example, ABPA involves an exaggerated immune response to Aspergillus in the airways. Steroids can reduce this inflammation and improve symptoms.

However, corticosteroids do not kill Aspergillus. They suppress immune activity and may increase susceptibility to infection. Their use in patients with fungal disease therefore requires careful clinical assessment.

Before taking prednisolone

Before starting treatment, tell your doctor or pharmacist about any other medical conditions or medicines you take.

It is particularly important to mention:

• Current or recent infections, including tuberculosis.
• Diabetes or raised blood sugar.
• High blood pressure or heart disease.
• Osteoporosis or previous fractures.
• Glaucoma or cataracts.
• Stomach ulcers or significant digestive problems.
• Liver or kidney disease.
• Previous serious mood changes or mental health problems.
• Previous steroid treatment or diagnosed adrenal insufficiency.
• Pregnancy, plans for pregnancy or breastfeeding.
• Recent exposure to chickenpox, shingles or measles.
• Any previous allergic reaction to corticosteroids.

Always provide an up-to-date list of medicines, including inhalers, nasal sprays, antifungal drugs and over-the-counter products.

How to take prednisolone

Always follow the instructions provided by your prescribing clinician.

• Prednisolone is commonly taken once daily in the morning, although some conditions require a different schedule.
• Taking it with or after food may reduce stomach discomfort.
• Soluble tablets should be dissolved according to the manufacturer’s instructions.
• Gastro-resistant tablets should be swallowed whole unless the product instructions say otherwise.
• Take the prescribed dose and do not increase it yourself.
• Follow your agreed treatment and dose-reduction plan.

Do not suddenly stop prednisolone if you may have developed adrenal suppression. The need for gradual dose reduction depends on the dose, treatment duration and individual circumstances.

Some short courses can be stopped without tapering, but repeated courses or longer treatment may require a more cautious approach.

Getting the most from treatment

• Read the Patient Information Leaflet supplied with your medicine.
• Keep a record of your steroid dose and any changes.
• Tell healthcare professionals, including dentists and surgeons, that you take corticosteroids.
• Check with a pharmacist before taking additional medicines.
• Ask whether you need monitoring of blood pressure, blood sugar, bone health or eye health.
• Discuss any troublesome side effects rather than stopping treatment independently.
• Ask whether you need a steroid treatment card or NHS Steroid Emergency Card.
• Keep up to date with recommended vaccinations, taking account of any precautions needed during immunosuppressive treatment.

Interactions with antifungal medicines

This is particularly important for patients with aspergillosis.

Some azole antifungal medicines, including itraconazole and voriconazole, inhibit enzymes involved in breaking down corticosteroids.

As a result, certain corticosteroids may remain in the body for longer and produce stronger systemic effects than expected.

This interaction is especially important with inhaled corticosteroids such as:

• Fluticasone.
• Budesonide.
• Some other inhaled or nasal corticosteroids.

Although these medicines are inhaled or sprayed into the nose, enough steroid may enter the circulation to cause significant problems when its breakdown is inhibited.

Possible consequences include:

• Cushing’s syndrome, caused by excessive corticosteroid exposure.
• Weight gain and changes in body fat distribution.
• Skin thinning and easy bruising.
• Muscle weakness.
• Raised blood sugar.
• Suppression of the body’s natural cortisol production.

Adrenal suppression may become particularly apparent when the steroid or interacting antifungal is reduced or stopped.

The risk varies according to the specific medicines, doses and duration of treatment. Not every steroid interacts to the same extent, and the same precautions do not apply equally to every antifungal.

Clinicians may consider a different corticosteroid, adjust treatment or arrange monitoring when these combinations are necessary.

Adrenal suppression and adrenal crisis

Your adrenal glands normally produce cortisol, a hormone essential for maintaining blood pressure, regulating metabolism and helping the body respond to illness or physical stress.

When corticosteroid medicines are taken for prolonged periods, the body may reduce its own cortisol production. This is called adrenal suppression.

It can occur with oral steroids and, in some circumstances, with high-dose inhaled steroids or steroid treatment combined with medicines that increase steroid exposure.

Symptoms of adrenal insufficiency may include:

• Unusual tiredness or weakness.
• Dizziness, particularly on standing.
• Loss of appetite.
• Nausea.
• Weight loss.
• Difficulty coping with illness or physical stress.

These symptoms can overlap with those of aspergillosis and other chronic illnesses, making diagnosis more difficult.

What is an adrenal crisis?

An adrenal crisis is a potentially life-threatening situation in which the body does not have enough cortisol to cope with its immediate needs.

It may be triggered by severe illness, infection, vomiting, surgery or interruption of essential steroid treatment.

Warning signs include:

• Severe weakness or sudden deterioration.
• Repeated vomiting or inability to keep medication down.
• Severe dizziness or fainting.
• Confusion or reduced consciousness.
• Very low blood pressure or collapse.

Suspected adrenal crisis is a medical emergency. Call 999. People with known adrenal insufficiency should follow their prescribed emergency steroid and sick-day management plan.

Patients at risk may need additional steroid treatment during illness, sometimes called sick-day dosing. The correct instructions depend on the individual and should be provided by their clinical team.

Steroid treatment cards and emergency cards

Two types of steroid card may be relevant.

Steroid treatment card

A steroid treatment card records information about corticosteroid use and reminds patients and healthcare professionals about important precautions.

NHS Steroid Emergency Card

The NHS Steroid Emergency Card identifies patients who are at risk of adrenal crisis because their bodies may not produce enough cortisol.

It alerts healthcare professionals that urgent steroid treatment may be required during serious illness or a medical emergency.

Not everyone prescribed a corticosteroid needs an emergency card. Eligibility depends on factors including the medicine, dose, duration of treatment and individual risk of adrenal suppression.

Ask your healthcare team whether you need a steroid treatment card, an NHS Steroid Emergency Card, or both.

Steroids and vaccinations

Vaccinations remain an important part of protecting people with chronic respiratory illness.

Most non-live vaccines, including routine influenza vaccines and currently used COVID-19 vaccines, can be given during corticosteroid treatment.

However, higher doses of systemic steroids may reduce the immune response to some vaccines.

Live vaccines require additional consideration because they may be unsuitable for people receiving immunosuppressive doses of corticosteroids.

Whether a vaccine is appropriate depends on the steroid dose, treatment duration, other medicines and the patient’s immune status.

Do not automatically avoid vaccination because you take steroids. Instead, discuss any necessary precautions with your GP, specialist team or vaccination service.

Possible side effects

Not everyone experiences side effects. The likelihood and severity generally increase with higher doses, longer courses and repeated exposure.

Common or important side effects

• Increased appetite and weight gain.
• Indigestion or stomach discomfort.
• Difficulty sleeping.
• Mood changes, irritability or anxiety.
• Raised blood sugar.
• Fluid retention.
• Increased susceptibility to infection.
• Thrush.
• Easy bruising and slower wound healing.

Longer-term side effects

• Osteoporosis and increased fracture risk.
• Muscle weakness or muscle wasting.
• Cataracts or glaucoma.
• Changes in body fat distribution.
• High blood pressure or worsening diabetes.
• Thinning of the skin.
• Adrenal suppression.

Mood, sleep and thinking

Corticosteroids can affect mood, sleep and concentration.

Some people experience increased energy or difficulty sleeping. Others develop anxiety, low mood, agitation or problems concentrating.

Occasionally, serious psychiatric symptoms such as mania, severe depression or psychosis can occur.

Tell your doctor promptly if you experience significant changes in mood, behaviour or thinking.

Do not independently stop steroid treatment because of side effects. Your clinician may be able to adjust the dose, change treatment or provide additional support.

When to get urgent help

Seek urgent medical assessment for:

• Symptoms suggesting a serious infection, particularly if you are deteriorating rapidly.
• Vomiting blood or passing black, tar-like stools.
• Sudden significant changes in vision.
• Severe changes in mood, behaviour or mental state.
• Severe or rapidly worsening breathing difficulties.
• Symptoms suggesting adrenal insufficiency during illness, particularly if you cannot keep steroid medication down.

Call 999 for life-threatening symptoms, including collapse, severe breathing difficulty or suspected adrenal crisis.

Storage and disposal

• Keep medicines out of the sight and reach of children.
• Follow the storage instructions on the packaging.
• Do not use medicines after their expiry date.
• Return unwanted medicines to a pharmacy for safe disposal.

Further information

• NHS: Prednisolone
• NHS: Side effects of prednisolone
• NHS: Adrenal insufficiency and Addison’s disease
• Electronic Medicines Compendium: Prednisolone patient information leaflets
• NHS: Vaccinations

Author and review information

This information is intended to support discussions with healthcare professionals and should not replace individual medical advice. Steroid treatment, dose reduction and emergency management should follow an agreed clinical plan.