Systemic Corticosteroids in Asthma: A Call to Action From World Allergy Organization and Respiratory Effectiveness Group

Eugene R Bleecker, Mona Al-Ahmad, Leif Bjermer, Marco Caminati, G Walter Canonica, Alan Kaplan, Nikolaos G Papadopoulos, Nicolas Roche, Dermot Ryan, Yuji Tohda, David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
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Abstract

Systemic corticosteroids (SCS) are a highly effective treatment for acute exacerbations and long-term symptom control in asthma. Long-term SCS use is highly prevalent across all asthma severities, occurring in over 20% of patients with severe or uncontrolled disease globally. It is now well known that exposure to both long-term and repeated acute courses of SCS is associated with a high risk of serious adverse effects (AEs), such as osteoporosis, and metabolic and
cardiovascular complications, especially when prescribed onto a background of other corticosteroids. The aim of this call-to-action article, endorsed by the World Allergy Organization and the Respiratory Effectiveness Group, is to review the accumulating evidence on the burden of SCS on patients with asthma and provide an overview of potential strategies for implementing SCS Stewardship.
Primary prevention of exacerbations and improvement of asthma control is a key first step in achieving SCS Stewardship, by optimizing maintenance asthma medications and addressing modifiable risk factors, such as adherence and inhaler technique. Other key elements of SCS Stewardship include increasing appropriate specialist referrals for multidisciplinary review, assessment of biomarkers, and consideration of oral corticosteroid-sparing add-on therapies (eg biologics). In cases where SCS use is deemed clinically justified, it should be tapered to the lowest possible dose. In addition, patients receiving long-term SCS or frequent acute courses should be closely monitored for emergence of SCS-related AEs. Because of the extensive data available on the costly and burdensome AEs associated with SCS use, as well as the range of treatment options now available, there is a need for healthcare providers (HCPs) to carefully evaluate whether the systemic Corticosteroids in Asthma benefits of SCS outweigh the potential harms, to adopt SCS-sparing and Stewardship strategies, and to consider alternative therapies where possible. Development of a structured and collaborative SCS Stewardship approach is urgently required to protect patients from the potential harm of SCS use.
Original languageEnglish
Article number100726
Number of pages16
JournalWorld Allergy Organization Journal
Volume15
Issue number12
Early online date10 Dec 2022
DOIs
Publication statusPublished - 10 Dec 2022

Bibliographical note

Acknowledgments
This manuscript was endorsed by the World Allergy Organization and the Respiratory Effectiveness Group. Editorial support was funded by AstraZeneca and was provided by Katherine Hardy, PhD of Helios Medical Communications, Oxford, Oxfordshire, UK
Funding
This manuscript was funded by a grant from AstraZeneca. The authors retained full control. AstraZeneca provided a review for scientific accuracy and did not participate in the content development.

Keywords

  • Severe asthma
  • systemic corticosteroids
  • adverse effects
  • burden

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