Systemic corticosteroids in asthma: A call to action from World Allergy Organization and Respiratory Effectiveness Group

Eugene R. Bleecker, MD; Mona Al-Ahmad, MD; Leif Bjermer, MD, PhD; Marco Caminati, MD; Giorgio Walter Canonica, MD; Alan Kaplan, MD, CCFP(EM), FCFP; Nikolaos G. Papadopoulos, MD, PhD; Nicolas Roche, MD, PhD; Dermot Ryan, FRCGP; Yuji Tohda, MD; Anahí Yáñez, MD; David Price, FRCGP

World Allergy Organization Journal (Dec 2022)

Systemic corticosteroids in asthma: A call to action from World Allergy Organization and Respiratory Effectiveness Group

Eugene R. Bleecker, MD,
Mona Al-Ahmad, MD,
Leif Bjermer, MD, PhD,
Marco Caminati, MD,
Giorgio Walter Canonica, MD,
Alan Kaplan, MD, CCFP(EM), FCFP,
Nikolaos G. Papadopoulos, MD, PhD,
Nicolas Roche, MD, PhD,
Dermot Ryan, FRCGP,
Yuji Tohda, MD,
Anahí Yáñez, MD,
David Price, FRCGP

Affiliations

Eugene R. Bleecker, MD: Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
Mona Al-Ahmad, MD: Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
Leif Bjermer, MD, PhD: Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
Marco Caminati, MD: Department of Medicine, University of Verona, Verona, Italy
Giorgio Walter Canonica, MD: Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
Alan Kaplan, MD, CCFP(EM), FCFP: Family Physician Airways Group of Canada, Stouffville, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
Nikolaos G. Papadopoulos, MD, PhD: Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK; Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital ‘P&A Kyriakou’, University of Athens, Athens, Greece
Nicolas Roche, MD, PhD: Department of Respiratory Medicine, APHP. Centre Université Paris Cité, Cochin Hospital (AP-HP) and Institute (UMR1016), Paris, France
Dermot Ryan, FRCGP: Usher Institute, University of Edinburgh, Edinburgh, UK
Yuji Tohda, MD: Kindai University Hospital, Osaka, Japan
Anahí Yáñez, MD: Center for Research on Allergies and Respiratory Diseases (InAER), Buenos Aires, Argentina
David Price, FRCGP: Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Corresponding author. Professor David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06 Midview City, Singapore 573969

Journal volume & issue: Vol. 15, no. 12
p. 100726

Abstract

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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 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.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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