Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb 5;29(155):190085.
doi: 10.1183/16000617.0085-2019. Print 2020 Mar 31.

How can we minimise the use of regular oral corticosteroids in asthma?

Arnaud Bourdin  1 , Ian Adcock  2 , Patrick Berger  3 , Philippe Bonniaud  4 , Philippe Chanson  5 , Cécile Chenivesse  6   7 , Jacques de Blic  8 , Antoine Deschildre  9 , Philippe Devillier  10 , Gilles Devouassoux  11   12 , Alain Didier  13 , Gilles Garcia  14 , Antoine Magnan  15 , Yan Martinat  16 , Thierry Perez  17   18 , Nicolas Roche  19 , Camille Taillé  20 , Pierre Val  21 , Pascal Chanez  22
Affiliations
Review

How can we minimise the use of regular oral corticosteroids in asthma?

Arnaud Bourdin et al. Eur Respir Rev. .

Abstract

Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key "research statement proposals" were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn't be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year-1 should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: A. Bourdin reports institutional fees for board membership from AstraZeneca, Novartis, GSK, Boehringer Ingelheim, Chiesi, Actelion, Pfizer and Teva, outside the submitted work. Conflict of interest: I. Adcock reports grants from EU-IMI, during the conduct of the study. Conflict of interest: P. Berger reports non-financial support from AstraZeneca, during the conduct of the study; personal fees and non-financial support from AstraZeneca, Sanofi, Circassia and Menarini grants, personal fees and non-financial support from Boehringer Ingelheim, and grants and personal fees from Novartis, outside the submitted work. Conflict of interest: P. Bonniaud reports personal fees and other from Roche, Boehringer, Novartis, personal fees from TEVA and AstraZeneca, and other from Chiesi and Stallergene, outside the submitted work. Conflict of interest: P. Chanson has nothing to disclose. Conflict of interest: C. Chenivesse reports grants and personal fees from AstraZeneca and Novartis, and personal fees from AIR LIQUIDE, ALK Abello, Boehringher Ingelheim, Chiesi, GSK, Sanofi and Teva, outside the submitted work. Conflict of interest: J. de Blic reports institutional fees for board membership from GSK, Boehringer Ingelheim, AstraZeneca, Novartis, Chiesi and Stallergenes, outside the submitted work. Conflict of interest: A. Deschildre reports personal fees from Novartis, TEVA, Stallergenes Greer, AImmune, Zambon, personal fees and other from ALK, GSK, Chiesi, AstraZeneca and DBV technologies, outside the submitted work. Conflict of interest: P. Devillier reports personal fees and non-financial support from AstraZeneca and Boehringer Ingelheim, and personal fees from Chiesi, GlaxoSmithKline, Novartis and Sanofi, outside the submitted work. Conflict of interest: G. Devouassoux reports personal fees from GSK, Astra Zeneca and Novartis, during the conduct of the study. Conflict of interest: A. Didier reports institutional fees for board membership from AstraZeneca, Novartis, GSK, Boehringer Ingelheim, Chiesi and Menarini, outside the submitted work. Conflict of interest: G. Garcia reports institutional fees for board membership from AstraZeneca, Novartis, GSK, Boehringer Ingelheim, Chiesi, Actelio, Pfizer and Teva, outside the submitted work. Conflict of interest: A. Magnan has nothing to disclose. Conflict of interest: Y. Martinat reports institutional fees for board membership from AstraZeneca, Novartis, GSK, Boehringer Ingelheim, Chiesi, Actelio, Pfizer and Teva, outside the submitted work. Conflict of interest: T. Perez reports institutional fees for board membership from Novartis, GSK, Boehringer Ingelheim and Chiesi, grants from AstraZeneca, and fees for travel from Chiesi, AstraZeneca, and Boehringer Ingelheim, outside the submitted work. Conflict of interest: N. Roche reports grants and personal fees from Boehringer Ingelheim, Novartis and Pfizer, and personal fees from Teva, GSK, AstraZeneca, Chiesi, Mundipharma, Sanofi, Sandoz, 3M, Zambon and Trudell, outside the submitted work. Conflict of interest: C. Taillé reports personal fees, non-financial support and other from AstraZeneca and from Novartis, grants, personal fees, non-financial support and other from GSK and Sanofi, and personal fees from Teva, during the conduct of the study. Conflict of interest: P. Val has nothing to disclose. Conflict of interest: P. Chanez reports grants and personal fees from Almirall, Boehringer Ingelheim, ALK, GSK, AstraZeneca, Novartis, Teva and Chiesi, and grants from AMU, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
A strategic step-by-step plan for sparing oral corticosteroids (OCS) in severe asthma. EGPA: eosinophilic granulomatosis with polyangiitis; ABPA: allergic bronchopulmonary aspergillosis; ICS: inhaled corticosteroid; CS: corticosteroid; LAMA: long-acting muscarinic antagonist; IL: interleukin; Ig: immunoglobulin; RCT: randomised controlled trial.
See this image and copyright information in PMC

References

    1. Barnes PJ. Drugs for asthma. Br J Pharmacol 2006; 147: Suppl. 1, S297–S303. - PMC - PubMed
    1. Chu EK, Drazen JM. Asthma: one hundred years of treatment and onward. Am J Respir Crit Care Med 2005; 171: 1202–1208. doi:10.1164/rccm.200502-257OE - DOI - PubMed
    1. Cameron SJ, Cooper EJ, Crompton GK, et al. . Substitution of beclomethasone aerosol for oral prednisolone in the treatment of chronic asthma. Br Med J 1973; 4: 205–207. doi:10.1136/bmj.4.5886.205 - DOI - PMC - PubMed
    1. Bousquet J, Chanez P, Lacoste JY, et al. . Eosinophilic inflammation in asthma. N Engl J Med 1990; 323: 1033–1039. doi:10.1056/NEJM199010113231505 - DOI - PubMed
    1. Global Initiative for Asthma (GINA) . 2018 GINA Report: Global Strategy for Asthma Management and Prevention. https://ginasthma.org/2018-gina-report-global-strategy-for-asthma-manage... Date last accessed: 19 September 2018. Date last updated: 2018.

Publication types

Substances