Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

Barra, Cristina Botelho; Fontes, Maria Jussara Fernandes; Cintra, Marco Túlio Gualberto; Cruz, Renata C; Rocha, Janaina A.G.; Guimarães, Maíla Cristina C; Silva, Ivani Novato

doi:10.1590/1806-9282.63.10.899

Cited by 11 publications

(11 citation statements)

References 31 publications

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“…There are always concerns about CS prescription and the risk of adrenal dysfunction. In a Brazilian study, the authors showed that even the use of CS for short‐term courses is associated with an increased risk of transitory suppression of the hypothalamic‐pituitary‐adrenal (HPA) axis . Nevertheless, they also highlighted that concomitant use of inhaled CS (ICS) does not impair adrenal recovery from occurring …”

Section: Pharmacokinetics and Side Effectsmentioning

confidence: 99%

Oral corticosteroids and asthma in children: Practical considerations

Filippo

Clark

Fillard

et al. 2020

Pediatric Allergy Immunology

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When dealing with allergic disorders, pediatricians may prescribe systemic corticosteroids (CS) to treat several different diseases, such as asthma, allergic rhinitis, allergic conjunctivitis, angioedema, eczema, certain types of food allergy, and anaphylaxis, and to prevent a delayed response. The main effects for which they are used in allergy are their anti-inflammatory effect, their ability to relax smooth muscle cells, and their action on the allergic delayed response. In clinical practice, corticophobia may raise doubts in patients and their families. For such reason, it is essential to well educate children and their caregivers: In a study by Najada et al, the authors showed that an appropriate education in managing asthma in children allowed a significant reduction in acute care visits and hospitalizations. 1 Here, we will focus on the prescription of oral CS in children with asthma and wheezing. | PHARMACOK INE TI C S AND S IDE EFFEC TSCorticosteroids bound to two plasma proteins: a corticosteroid-binding globulin (also called "transcortin") and albumin. Nevertheless, only the unbound free fraction is biologically active. 2 CS metabolism is essentially hepatic, being catalyzed by enzymes of the cytochrome P450 family. The pharmacokinetics of CS does not differ between asthmatic and non-asthmatic patients. 2The main side effects of CS in the pediatric population include growth impairment, pubertal disorders, and hirsutism. In adults, the main side effects include acne, delayed cicatrization, the possible appearance of glaucoma, and posterior cataract, and increase the risk of bone fracture. At any age, the use of CS is associated with an increased risk of diabetes, hypertension, and virus reactivation. 2 There are always concerns about CS prescription and the risk of adrenal dysfunction. In a Brazilian study, the authors showed that even the use of CS for short-term courses is associated with an increased risk of transitory suppression of the

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Section: Pharmacokinetics and Side Effectsmentioning

confidence: 99%

Oral corticosteroids and asthma in children: Practical considerations

Filippo

Clark

Fillard

et al. 2020

Pediatric Allergy Immunology

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show abstract

“…bioavailability, protein‐binding affinities, plasma half‐life and metabolic inactivation and clearance) [ 13 ]. Repeat courses of OCS are also a risk factor for AI [ 18 ], and patients with a predisposition to HPA axis dysfunction as a consequence of other underlying conditions or medications may be particularly susceptible to AI caused by OCS [ 27 ]. Still, the risk of AI can be reduced, though not fully negated, by using the lowest effective dosage of OCS for the shortest amount of time [ 16 ].…”

Section: Adrenal Insufficiencymentioning

confidence: 99%

Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma

et al. 2021

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“…exacerbations. However, this use is not desirable, as repeated usage of systemic corticosteroid is associated with cumulative systemic adverse events and persistent negative impact on the hypothalamic-pituitaryadrenal (HPA) axis [10]. Nevertheless, it is difficult to avoid systemic corticosteroid use completely as it may be the last option for treatment of acute exacerbations [1,11,12].…”

Section: Management Of Severe Asthma: What Guidelines Recommendmentioning

confidence: 99%

Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma

Κatsaounou

Buhl²,

Brusselle

et al. 2019

Respiratory Medicine

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Systemic/oral corticosteroids (OCS) have been used for decades in the management of acute asthma exacerbations and chronically in patients with uncontrolled severe asthma. However, while OCS are effective at treating acute exacerbations, there is only empirical evidence regarding the efficacy of OCS at reducing the rate of exacerbations. Evidence, although scarce, is suggestive of high exacerbation rates in severe asthma patients even when receiving maintenance treatment with OCS. In addition, use of OCS is associated with undesirable effects. Despite all this, physicians have continued to use OCS for managing severe asthma and acute exacerbation due to the lack of availability of effective alternatives. Fortunately, in the last decade several biologics have been proven safe and effective for patients with uncontrolled severe asthma. This has led to the Global Initiative for Asthma (GINA) recommending the use of biologics, instead of maintenance OCS, in patients with severe asthma (GINA Step 5). These include one biologic targeting immunoglobulin E (IgE) (omalizumab), and different biologics targeting interleukin-5 (IL-5), the IL-5 receptor (IL-5R) or IL-4 receptor α-unit (IL-4R α), including mepolizumab (subcutaneous), reslizumab (intravenous), benralizumab (subcutaneous) and dupilumab (subcutaneous).Omalizumab for the treatment of severe allergic asthma reduces exacerbations, irrespective of blood eosinophil levels. Anti-IL-5/IL-5R biologics are indicated in patients with severe eosinophilic asthma and repetitive exacerbations, irrespective of the presence or absence of allergy. Recently, an anti-IL4Rα biologic has been approved by the FDA for eosinophilic phenotype or oral corticosteroid-dependent asthma. Finally, physicians should consider using biologics as an alternative to chronic OCS therapy.

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Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

Abstract: Oral cOrticOsterOids fOr asthma exacerbatiOns might be assOciated with adrenal suppressiOn: are physicians aware Of that? rev assoC med bras 2017; 63(10):899-903 899

Cited by 11 publications

References 31 publications

Oral corticosteroids and asthma in children: Practical considerations

Oral corticosteroids and asthma in children: Practical considerations

Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma

Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma

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