Oral corticosteroid-dependent asthma: a 30-year review

Advances in Asthma Management

“…The prevalence of ABPA is estimated to be 1-2% of all patients with asthma [15]. It is defined as a hypersensitive disorder to the aspergillus species with five of the major criteria for the diagnosis of ABPA (in noncystic fibrosis individuals) being required [14,16,17].…”

“…These include both short-acting b2-agonists (SABA; e.g., salbutamol or terbutaline) and long-acting b2-agonists (LABA; e.g., formoterol). Interestingly, the use of formoterol as reliever therapy in patients receiving maintenance ICS therapy has been shown to reduce the risk of severe exacerbations when compared with terbutaline [14]. Nonetheless, none of the inhaled b2-agonists have been convincingly shown to treat the underlying asthmatic inflammatory process [15] and overuse of b2-agonists when used as monotherapy in asthma has been associated with severe asthma exacerbations, resulting in asthma hospitalizations and increased asthma mortality [16,17].…”

“…It should be accompanied by the use of b 2 -agonists. A Cochrane review, which included 2066 children and 614 adults in emergency department, indicated that metered-dose inhalers with spacers yielded outcomes at least as good as those for nebulizer delivery [14]. The approach of early treatment with oral corticosteroids for acute asthma has been found to reduce hospital admission rates and risk of relapse, with benefits appearing to be greatest in patients with more severe asthma.…”

“…The link between asthma and psychopathology has long been recognized [14,15]. There is extensive literature confirming that psychological dysfunction is common in people with asthma, and suggesting that psychological and emotional factors may influence asthma outcomes and behaviors important in asthma, such as adherence to prescribed therapy and smoking.…”

“…Cross-sectional surveys consistently report high levels of psychological morbidity in people with asthma of all ages, particularly of clinically important anxiety and depression. The risk of clinically relevant anxiety and/or depression in people with asthma has been reported as being from between two-and eight-times that observed in the nonasthma population, although underdiagnosis and underappreciation by clinicians is common [14]. Anxiety and depression are particularly found in association with severe and difficult to control asthma, where the prevalence of either or both may be up to 50%, although again frequently unrecognized.…”