Oral steroids in asthma: a double-edged sword

Gaga, Mina; Ζervas, Εleftherios

doi:10.1183/13993003.02034-2019

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…Generally, acute exacerbations of asthma following pneumonia can increase emergency room visits and admission rates, which could lead to poor outcomes, such as respiratory failure or death. Moreover, patients with severe asthma are exposed to prolonged, high-dose systemic corticosteroids, which could increase the mortality by developing systemic diseases, such as hypertension, diabetes, osteoporosis, and impaired humoral immunity 11 , 12 .…”

Section: Introductionmentioning

confidence: 99%

Impact of comorbid asthma on severity of coronavirus disease (COVID-19)

Lee

Son

Han

et al. 2020

Sci Rep

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The severity of the coronavirus disease (COVID-19) is associated with various comorbidities. However, no studies have yet demonstrated the potential risk of respiratory failure and mortality in COVID-19 patients with pre-existing asthma. We selected 7272 adult COVID-19 patients from the Korean Health Insurance Review and Assessment COVID-19 database for this nationwide retrospective cohort study. Among these, 686 patients with asthma were assessed by their severities and evaluated by the clinical outcome of COVID-19 compared to patients without asthma. Of 7272 adult COVID-19 patients, 686 with asthma and 6586 without asthma were compared. Asthma was not a significant risk factor for respiratory failure or mortality among all COVID-19 patients (odds ratio [OR] = 0.99, P = 0.997 and OR = 1.06, P = 0.759) after adjusting for age, sex, and the Charlson comorbidity score. However, a history of acute exacerbation (OR = 2.63, P = 0.043) was significant risk factors for death among COVID-19 patients with asthma. Asthma is not a risk factor for poor prognosis of COVID-19. However, asthma patients who had any experience of acute exacerbation in the previous year before COVID-19 showed higher COVID-19-related mortality, especially in case of old age and male sex.

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Section: Introductionmentioning

confidence: 99%

Impact of comorbid asthma on severity of coronavirus disease (COVID-19)

Lee

Son

Han

et al. 2020

Sci Rep

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“…It is a heterogeneous disease characterized by persistent cough, wheezing, and dyspnea; affecting the lower respiratory tract [46,47]. Further, the management of asthma includes long-term exposure to systemic corticosteroids which increases risk of other disease conditions including hypertension, diabetes, and impaired humoral immunity [48]. In studying the relation between asthma exacerbation in COVID-19, published reports till date are divided in the findings, which continues to be intriguing as Coronaviridae have been associated with asthma exacerbation in up to 27% of the adults [49].…”

Section: Covid-19 and Asthmamentioning

confidence: 99%

Covid-19 Transmission, Risks Factors and Disease Characteristics in Asthmatics Patients

Alduraywish

2022

Postępy Mikrobiologii - Advancements of Microbiology

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Background The World Health Organizations (WHO) scientific brief on the coronavirus 2019 (COVID-19) pandemic and asthma from 2021, states individuals with asthma to be at a higher risk of respiratory infections as recorded in the annual influenza season. However, existing data from the COVID-19 pandemic does not till date establish an association of the disease with asthma. The disease burden of COVID-19 among asthmatic patients has not been very evident. This paucity of information forms the main rationale of our literature review, which is focused on collecting scattered literature around transmission, risks, as well as disease characteristics of COVID-19 among asthmatics world over including Saudi Arabia. Methodology This study report has been generated after detailed literature survey using keywords “asthma”, “coronavirus”, “COVID-19” and SARS-CoV-2 including quality high impact publications on relevant focus area through Google Scholar, Web of Science, and PubMed. Publication between year 2019 and 2021 were selected in specific to ensure the focus of the current literature review does not lose relevance in space of time. Results Our literature review identified elderly to have been reported to have high susceptibility to COVID-19; the risk being exacerbated among those with comorbidities. Further, no specific directives on asthma being one of the risk factors was found to be reported, especially with the current disease management strategy for COVID-19. The severely diseased COVID-19 patients also have been reported to exhibit increase in multiple cytokines, which may increase airway inflammation and exacerbate asthma attacks. However, contrary literature reports indicate an increase in T cells to reduce the disease impact of COVID-19. Conclusion There is paucity in significant evidence as of writing this review article to highlight exclusive negative impact of COVID-19 on asthmatics. Asthma patients however need to be recommended care pertaining to having their controller medication as new data continue to emerge on the clinic-pathological factors of the novel coronavirus.

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“… 11 – 14 Thus, some of the effect of atopic eczema on fracture risk could be mediated through oral corticosteroids, especially in those with more severe atopic eczema, who may be treated more frequently with oral corticosteroids. Asthma, a common comorbidity in people with atopic eczema, is also commonly treated with oral steroids, 15 , 16 and consequently may confound the relationship between atopic eczema and fractures.…”

Section: Introductionmentioning

confidence: 99%

Atopic Eczema–Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study

Matthewman

Mansfield

Prieto‐Alhambra

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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Background Evidence suggests adults with atopic eczema have increased fracture risk. However, it is unclear whether oral corticosteroids explain the association. Objective To assess to what extent oral corticosteroids mediate the relationship between atopic eczema and fractures. Methods We conducted a cohort study using English primary care (Clinical Practice Research Datalink) and hospital admissions (Hospital Episode Statistics) records (1998-2016) including adults (18+) with atopic eczema matched (age, sex, and general practice) with up to five adults without atopic eczema. We used Cox regression to estimate hazard ratios (HRs) for specific major osteoporotic fractures (hip, spine, pelvis, wrist) and for any-site fracture comparing individuals with atopic eczema to those without, adjusting for six different definitions of time-updated oral corticosteroid use (ever any prescription, ever high dose, and recent, cumulative, current or peak dose). Results We identified 526,808 individuals with atopic eczema and 2,569,030 without. We saw evidence of an association between atopic eczema and major osteoporotic fractures (e.g., spine HR 1.15 99%CI 1.08–1.22; hip HR 1.11 99%CI 1.08–1.15) that remained after additionally adjusting for oral corticosteroids (e.g., cumulative corticosteroid dose: spine HR 1.09 99%CI 1.03–1.16; hip HR 1.09 99%CI 1.06–1.12). Fracture rates were higher in people with severe atopic eczema compared to people without even after adjusting for oral corticosteroids (e.g., spine HR [99%CI]: confounder adjusted 2.31 [1.91–2.81]; additionally adjusted for cumulative dose 1.71 [1.40–2.09]). Conclusion Our findings suggest that little of the association between atopic eczema and major osteoporotic fractures is explained by oral corticosteroid use.

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Oral steroids in asthma: a double-edged sword

Abstract: There is poor evidence on the benefits of long-term systemic steroid use in asthma while the risks of morbidity and mortality are high. Systemic steroids should be a last resort and should be withdrawn in non-responders.

Cited by 8 publications

References 19 publications

Impact of comorbid asthma on severity of coronavirus disease (COVID-19)

Impact of comorbid asthma on severity of coronavirus disease (COVID-19)

Covid-19 Transmission, Risks Factors and Disease Characteristics in Asthmatics Patients

Atopic Eczema–Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study

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