Systematic Literature Review of Systemic Corticosteroid Use for Asthma Management

Abstract

Systemic corticosteroid use to manage uncontrolled asthma and its associated healthcare burden may account for important health-related adverse effects. We conducted a systematic literature review to investigate the real-world extent and burden of systemic corticosteroid use in asthma. We searched MEDLINE and Embase databases to identify English-language articles published in 2010-2017, using search terms for asthma with keywords for oral corticosteroids and systemic corticosteroids. Observational studies, prescription database analyses, economic analyses, and surveys on oral/systemic corticosteroid use in children (>5 yr old), adolescents (12-17 yr old), and adults with asthma were included. We identified and reviewed 387 full-text articles, and our review included data from 139 studies. The included studies were conducted in Europe, North America, and Asia. Overall, oral/systemic corticosteroids were commonly used for asthma management and were more frequently used in patients with severe asthma than in those with milder disease. Long-term oral/systemic corticosteroid use was, in general, less frequent than short-term use. Compared with no use, long-term and repeated short-term oral/systemic corticosteroid use were associated with an increased risk of acute and chronic adverse events, even when doses were comparatively low. Greater oral/systemic corticosteroid exposure was also associated with increased costs and healthcare resource use. This review provides a comprehensive overview of oral/systemic corticosteroid use and associated adverse events for patients with all degrees of asthma severity and exposure duration. We report that oral/systemic corticosteroid use is prevalent in asthma management, and the risks of acute and chronic complications increase with the cumulative oral corticosteroid dosage.

Keywords: asthma; oral corticosteroids; severe asthma; systematic literature review; systemic corticosteroids.

Figure 1.

Flow diagram of the article screening and evaluation process. *“Other” included asthma–chronic obstructive pulmonary disease overlap syndrome (n = 5), letter (n = 4), erratum (n = 2), not English language (n = 2), and retracted publication (n = 1). ^†“Other” included cost-effectiveness modeling, letter, not patients with asthma, not English language, asthma phenotyping analysis, controlled trial, and retracted publication (each n = 1). ED = emergency department.