Format

Send to

Choose Destination
Respirology. 2019 Nov 12. doi: 10.1111/resp.13730. [Epub ahead of print]

Rational oral corticosteroid use in adult severe asthma: A narrative review.

Author information

1
Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia.
2
Department of Respiratory Medicine, Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia.
3
Department of Respiratory and Sleep Medicine, Monash Medical Centre, Monash University, Melbourne, VIC, Australia.
4
Allergy, Asthma and Clinical Immunology, Alfred Hospital, Melbourne, VIC, Australia.

Abstract

OCS play an important role in the management of asthma. However, steroid-related AE are common and represent a leading cause of morbidity. Limited published studies suggest OCS usage varies across countries and recent registry data indicate that at least 25-60% of patients with severe asthma in developed countries may at some stage be prescribed OCS. Recent evidence indicate that many patients do not receive optimal therapy for asthma and are often prescribed maintenance OCS or repeated steroid bursts to treat exacerbations. Given the recent progress in adult severe asthma and new treatment options, judicious appraisal of steroid use is merited. A number of strategies and add-on therapies are now available to treat severe asthma. These include increasing specialist referral for multidisciplinary assessments and implementing OCS-sparing interventions, such as improving guideline adherence and add-on tiotropium and macrolides. Biologics have recently become available for severe asthma; these agents reduce asthma exacerbations and lower OCS exposure. Further research, collaboration and consensus are necessary to develop a structured stewardship approach including realistic OCS-weaning programmes for patients with severe asthma on regular OCS; education and public health campaigns to improve timely access to specialized severe asthma services for treatment optimization; and implementing targeted strategies to identify patients who warrant OCS use using objective biomarker-based strategies.

KEYWORDS:

asthma; biological products; glucocorticoids; health promotion; morbidity

PMID:
31713955
DOI:
10.1111/resp.13730
Free full text

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center