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Overuse of oral corticosteroids is underdiagnosed in asthma patients

Published: April 08, 2022

Oral corticosteroids (OCS) are powerful anti-inflammatory drugs, and 25% to 40% of all OCS prescriptions are attributable to respiratory conditions, especially airway diseases. For asthma this includes short OCS courses to treat acute episodes of asthma, as well as maintenance OCS therapy in patients with severe asthma. Despite their benefits, OCS have well-known long-term side effects. Nevertheless, OCS are widely prescribed, and many asthma patients are exposed to potentially toxic cumulative doses. This is associated with increases in non-asthma-related health care use and costs, but above all it poses a significant burden to patients. Van der Meer et al. in a recent article published in The Journal of Allergy and Clinical Immunology: In Practice investigated the prevalence of OCS users with asthma, as well as the involvement of specialists and general practitioners (GPs) in the prescription of OCS in patients with asthma of different levels of severity. Better understanding of OCS prescription could greatly improve asthma treatment and help to avoid unnecessary OCS exposure.

Three objectives were investigated: (1) the prevalence of asthma patients requiring 2 or more OCS courses or maintenance use of OCS (ie, frequent users), (2) their use of inhaled corticosteroids (ICS), and (3) who prescribed their asthma medications. The authors analyzed data from the Dutch IQVIA Prescription Database focusing on adult patients receiving asthma medication during one focus year. An OCS course was defined as 20mg prednisolone equivalent or more, for 3 to 28 days; maintenance OCS use as 2.5 to 17.5mg/day for over 28 days. Prescribers were classified as specialist or GPs.

The study showed that 7.2% of Dutch patients with asthma were overexposed to OCS, of whom only about half used adequate doses of ICS, and 40.3% had not undergone intervention of an asthma specialist for years. This suggests that OCS overuse is often underdiagnosed and inadequately addressed. Awareness of inappropriate OCS prescribing patterns may contribute to good “corticosteroid stewardship” by specialists, GPs, and patients. OCS overuse could be drastically reduced if workup and therapy adjustment protocols are implemented, and better education is provided about new targeted treatments. These measures will ultimately minimize the dreaded long-term side effects of OCS therapy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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