Advances with glucocorticoids in the treatment of asthma: state of the art

ABSTRACT

Introduction

Asthma is one of the most frequent chronic diseases all over the world. Glucocorticoids (GCs), both inhaled (ICSs) and oral (OCSs), are the most effective treatment in asthma because they control symptoms and prevent exacerbations.

Areas covered

The present article reviews the new therapeutic indications of GCs for the treatment of asthma and focuses on new molecules and safety issues.

Expert opinion

Most patients with asthma benefit from corticosteroid-based treatments. Side effects are mainly due to prolonged use of oral GCs, while they are minor with inhaled GCs. Interesting insights come from the new ICSs, which are characterized by lower oral bioavailability and higher lipophilicity and are more effective with less side effects. Recent trials have shown the efficacy of early use of ICSs in mild asthma. Furthermore, the possibility to prescribe targeted therapies using specific biomarkers in steroid-sensitive asthma can reduce doses and duration of treatment, while biological agents should be reserved for non-responding patients. All this evidence confirm the need to continue on the path toward precision medicine, in which the treatments are based on clinical and molecular traits.

KEYWORDS:

• Asthma
• safety
• mechanism of action
• inhaled corticosteroids
• glucocorticoids receptor agonists

Article highlights

• Glucocorticoids are the main therapy for all asthma severity groups and are effective in most patients.

• Side effects of oral glucocorticoid regimens depend on doses and length of the therapy

• New inhaled glucocorticoids have less oral bioavailability and a greater lipophilicity, thus a greater efficacy with fewer side effects.

• Identification of new biomarkers will allow to target the therapy in corticosteroid-sensitive asthma patients as well as to shorten therapies and use smaller doses, reserving biological agents for non-responsive patients.

To move from one-fits-all therapies to targeted therapies based on treatable clinical or molecular traits is the new frontier of asthma research.

This box summarizes key points contained in the article.

Declaration of interest

J Ora has participated as a speaker in scientific meetings and courses under the sponsorship of

AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, and Novartis. P Rogliani has participated as a lecturer, speaker, and advisor in scientific meetings and on courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Mundipharma, and Novartis. Her department was funded by Almirall, Boehringer Ingelheim, Novartis, and Zambon. MG Matera has participated as a lecturer, speaker, and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline and Novartis, and has been a consultant to Chiesi Farmaceutici. L Calzetta has participated as an advisor in scientific meetings under the sponsorship of Boehringer Ingelheim and Novartis, received non-financial support by AstraZeneca, received a research grant partially funded by Boehringer Ingelheim, Novartis and Almirall, and is or has been a consultant to Edmond Pharma, Zambon and Verona Pharma. His department was funded by Almirall, Boehringer Ingelheim, Novartis, and Zambon. Finally, M Cazzola has participated as a lecturer, speaker, and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Lallemand, Mundipharma, Novartis, Pfizer, Verona Pharma, and Zambon, and is or has been a consultant to Chiesi Farmaceutici, Edmond Pharma Lallemand, Novartis, Verona Pharma, and Zambon. His department was funded by Almirall, Boehringer Ingelheim, Novartis, and Zambon. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.