Oral steroids such as prednisone have been widely used for decades to treat severe asthma.
While these can be powerful medications, oral corticosteroids work better in some people than in others. And the long-term use of oral steroids carries the risk of serious side effects, including growth suppression in children, bone thinning, diabetes, weight gain, eye disorders such as glaucoma and cataracts, high blood pressure and heart attacks.
“How concerned should we be about the use of oral corticosteroids? I think quite concerned,” said Dr. J. Allen Meadows, outgoing president of the American College of Allergy, Asthma & Immunology (ACAAI), during a presentation at the 2020 Annual Scientific Meeting, held virtually Nov. 13 to 15.
To avoid steroid overuse, physicians must carefully monitor patients’ “cumulative steroid dose” – or the amount that each patient is taking and for how long. “As healthcare providers, we can do our part through oral corticosteroid stewardship,” Meadows said.
Severe asthma is defined as asthma with symptoms that aren’t well controlled with inhaled corticosteroids and long-acting beta-agonists, at least two asthma exacerbations during the previous year, and at least one hospital admission.
Between 11 and 38 percent of patients with severe asthma in the U.S. take oral steroids over the long-term, according to studies cited in the presentation. Cumulative steroid exposure should take into account both oral steroids, as well as high-dose inhaled steroids, noted Dr. Arnaud Bourdin of the University of Montepellier in France.
One Size Doesn’t Fit All
Physicians should also recognize that asthma treatment isn’t “one-size-fits-all” approach, Meadows noted. Some patients with severe asthma respond to steroids like prednisone better than others due to their asthma “phenotype,” or the characteristics of the disease, he explained.
Asthma phenotypes can be influenced by genes and gene expression, and include factors such as what triggers asthma symptoms, and the type of underlying inflammation in the airways.
When prescribing oral steroids, doctors should make sure that the people taking them are actually being helped by the drugs, the presenters stressed. Physicians also need to monitor whether patients are using their inhaled steroid medications as prescribed, and are using proper inhaler technique. This ensures patients are getting the most benefit from controller medications and are not relying on oral steroids unnecessarily.
Managing oral steroid use should also include tapering, in which doses are gradually reduced over time to ensure patients are taking the lowest dose necessary to control their symptoms, Bourdin said.
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