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Some of the typical examples are steroid inhalers that help treat asthma, and steroid injections, whose use is evident in treating joint and ligament pains.

The FDA approved the sale of steroid inhalers for the treatment of chronic obstructive pulmonary disease, or COPD, in 2009. In January 2010, the FDA approved the first commercial product, the Alkali TFX inhaler.

Steroid users aren’t required to get a physical exam before taking the inhaler. The inhaler carries no warning to patients that the substance may be harmful to them, nor requires a drug-screening test to determine its level of risk.

Despite its strong reputation, the evidence that asthma sufferers may be helped by steroids, and the lack of a medical need to prescribe them, have not been established. In one study, a woman who reported feeling “familiar with steroids” was diagnosed with asthma by a doctor without ever taking steroids. A second woman with asthma who reported taking steroids showed no physical changes in her condition. That’s perhaps because, as the paper noted, steroid injections appear to have a mild effect on “cognitive performance, as measured by the MMPI/VIPI” — suggesting a mild benefit after the patient is on steroids.

Nevertheless, as the Journal of the American Medical Association noted, “injections with steroids are now routinely recommended by some pediatricians.” Among the risks of steroid use include asthma and bone deterioration. The U.S. Food and Drug Administration has a list of risks and cautions.

It’s not clear why the FDA has allowed the sale of steroids to patients for less than it has required in the past, including a three-year phase out period for inhalers after the 2009 FDA approval of a prescription medicine for respiratory disease.

The most recent FDA advisory to doctors on steroid inhalants, released last November, says, “The use of an inhaled corticosteroid product may increase the risk for bronchospasm, transient ischemic attacks, and exacerbation of asthma. … Patients should take extra caution and keep these medications within therapeutic limits when using an inhaled corticosteroid (e.g. 20 mcg (ml) per kg of body weight per day, for as long as they maintain the use of the inhaler).”

Despite its warnings, many doctors still do prescribe steroids for severe colds, bronchitis to treat asthma and asthma symptoms.

But that shouldn’t be taken as a sign the government is taking a lax approach to the drug, said Dr. William F. Deeds, chairman of the department of medicine at

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