Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand

Abstract

Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to introduce OCS stewardship approaches, akin to successful initiatives that optimized appropriate antibiotic usage. The aim of this TSANZ (Thoracic Society of Australia and New Zealand) position paper is to review current knowledge pertaining to OCS use in asthma and then delineate principles of OCS stewardship. Recent evidence indicates overuse and over-reliance on OCS for asthma and that doses >1000 mg prednisolone-equivalent cumulatively are likely to have serious side effects and adverse outcomes. Patient perspectives emphasize the detrimental impacts of OCS-related side effects such as weight gain, insomnia, mood disturbances and skin changes. Improvements in Laurence Ruane and John Gornall are consumer representatives.

Long-term effect of asthma on the development of obesity among adults: an international cohort study, ECRHS

“…First, our observation of higher obesity risk in asthmatics who took OCS, advocates the minimal and precise use of OCS in asthma 40. Although current recommendations of OCS for asthma management, several reports also indicate that oral steroids are still prescribed indiscriminately in asthma, sometimes, even without diagnosing the severity of the disease properly 41–43. This could result in an increasing burden of adverse health effects in asthma, obesity being one of the major consequences.…”

Treatable traits in asthma: moving beyond diagnostic labels

“…This attests to the complexity and heterogeneity of airway disease, neither of which are captured with the simple label of asthma. In both asthma and COPD, each additional trait identified was associated with a clinically significant decrement in health status, many of which are associated with an increased risk of future asthma attacks 6 . These results demonstrate the clinical importance of identifying the many treatable traits that are present in people with obstructive airway disease, and provides a mechanism to do this via multidimensional assessment of trait prevalence.…”

“…The need to improve outcomes for people with asthma is therefore great. Despite advances in treatment, people continue to die, they experience an ongoing burden from acute attacks 5 and symptoms, 3 and those with severe disease suffer severe iatrogenic consequences of treatment, in particular from oral corticosteroids 6 . This results in major deleterious impacts on patients’ relationships, their ability to live the life they desire, and workplace absenteeism and loss of productivity 3 …”

Trends and predictors of specialist assessments in oral corticosteroid treated asthma among young adults

“…Recent studies have mainly focused on the referral pathways among severe asthma populations [ 3 , 4 , 14 , 15 ], but if the overall OCS use in asthma management is to be minimised, a focus on general asthma populations is called for. A great deal of inappropriate OCS use occurs in mild–moderate asthma which may be poorly controlled due to underuse of ICS and/or poor adherence [ 9 , 16 ]. The most important problem in suboptimally treated asthma is recurrent exacerbations, decline of pulmonary function and OCS-associated side-effects [ 5 , 7 , 16 ].…”