The role of systemic corticosteroids in severe asthma and new evidence in their management and tapering

ABSTRACT

Introduction

Based on the latest literature evidence, between 30% and 60% of adults with severe refractory asthma (SRA) are systemic corticosteroid (SCS) dependent. There are numerous therapeutic options in asthma, which are often not effective in severe forms. In these cases, SCS should be considered, but it is increasingly recognized that their regular use is often associated with significant and potentially serious adverse events.

Areas covered

The aim of this article is to provide an update about the recent and significant literature on SCS and to establish their role in the management of SRA. We summarized the most important and recent evidence and we provided useful indications for clinicians.

Expert opinion

There is now strong evidence supporting the increased risk of comorbidities and complications with long-term SCS therapies, regardless of the dose. New evidence on SCS tapering and withdrawal will allow to define protocols to address SCS management with greater safety and effectiveness, after starting efficient steroid-sparing strategies. In the next 5years, it will be necessary to implement corrective actions to address these unmet needs, to reduce the inappropriate use of SCS by maximizing the application of more innovative and effective therapies.

KEYWORDS:

• Severe refractory asthma
• corticosteroids
• exacerbations
• side effects
• tapering
• biologics

Article highlights

• Between 30% and 60% of adults with severe refractory asthma (SRA) are systemic corticosteroid (SCS) dependent.

• Long-term SCS, even at low doses, significantly increase the risk of comorbidities and side effects.

• SCS still play a crucial role in SRA management, despite the growing awareness of their many and often serious side effects.

• Several issues currently present in the management of SRA, including those concerning SCS side effects, dose tapering and the application of steroid-sparing strategies, could benefit from a more extensively applied multidisciplinary approach.

• New evidence on OCS tapering and withdrawal, including data from the recent Ponente study, will allow to define protocols to address OCS management with greater safety and effectiveness after starting efficient steroid-sparing strategies including biological therapies.

This box summarizes key points shown in the article.

Reviewer disclosures

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

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.