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Review
. 2023 Jun;40(6):2577-2594.
doi: 10.1007/s12325-023-02479-0. Epub 2023 Apr 7.

A Charter to Fundamentally Change the Role of Oral Corticosteroids in the Management of Asthma

John Haughney  1 , Tonya Winders  2   3 , Steve Holmes  4 , Pascal Chanez  5 , Andrew Menzies-Gow  6 , Janwillem Kocks  7   8   9   10 , Adel H Mansur  11 , Christopher McPherson  12 , Giorgio Walter Canonica  13   14
Affiliations
Review

A Charter to Fundamentally Change the Role of Oral Corticosteroids in the Management of Asthma

John Haughney et al. Adv Ther. 2023 Jun.

Abstract

Asthma affects 339 million people worldwide, with an estimated 5-10% experiencing severe asthma. In emergency settings, oral corticosteroids (OCS) can be lifesaving, but acute and long-term treatment can produce clinically important adverse outcomes and increase the risk of mortality. Therefore, global guidelines recommend limiting the use of OCS. Despite the risks, research indicates that 40-60% of people with severe asthma are receiving or have received long-term OCS treatment. Although often perceived as a low-cost option, long-term OCS use can result in significant health impairments and costs owing to adverse outcomes and increased utilization of healthcare resources. Alternative treatment methods, such as biologics, may produce cost-saving benefits with a better safety profile. A comprehensive and concerted effort is necessary to tackle the continued reliance on OCS. Accordingly, a threshold for OCS use should be established to help identify patients at risk of OCS-related adverse outcomes. Receiving a total dose of more than 500 mg per year should trigger a review and specialist referral. Changes to national and local policies, following examples from other chronic diseases, will be crucial to achieving this goal. Globally, multiple barriers to change still exist, but specific steps have been identified to help clinicians reduce reliance on OCS. Implementing these changes will result in positive health outcomes for patients and social and economic benefits for societies.

Keywords: Asthma; Long-term; Oral corticosteroids.

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Conflict of interest statement

John Haughney has consultancy agreements with AstraZeneca for the PRECISION program and has received consulting or speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, and Teva. Tonya Winders has received consulting and speaker fees from AstraZeneca, GlaxoSmithKline, Sanofi, Regeneron, ALK-Abelló, and Novartis. Steve Holmes has consultancy agreements with AstraZeneca for the PRECISION program and has received consulting or speaker fees from AstraZeneca, Beximco, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Johnson & Johnson, Mylan, Napp, Novartis, Nutricia, Orion, Pfizer, Sandoz, Teva, and Trudell Medical International. Pascal Chanez has consultancy agreements with AstraZeneca for the PRECISION program and has received research and consulting funding from AstraZeneca, Almirall, Boehringer Ingelheim, Centocor, GlaxoSmithKline, Merck Sharp & Dohme, Novartis, Teva, Chiesi, and Schering-Plough. Andrew Menzies-Gow reports consultancy agreements with AstraZeneca and Sanofi; was an advisory board member for AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, Regeneron, and Teva; received speaker fees from AstraZeneca, Novartis, Teva, and Sanofi; has participated in research that his institution has been remunerated for from AstraZeneca and has attended international conferences sponsored by Teva. Janwillem Kocks reports grants, personal fees, and nonfinancial support from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline; reports grants and personal fees from Chiesi and Teva; reports grants from Mundi Pharma; has received personal fees from Merck Sharp & Dohme; has received personal fees from Covis Pharma outside of the submitted work; and holds 72.5% of shares in the General Practitioners Research Institute. Adel H. Mansur has received personal and institutional payments for talks and advisory board meetings, as well as grants from AstraZeneca, GlaxoSmithKline, Novartis, Teva, Sanofi, Boehringer Ingelheim, and Cheisi. Christopher McPherson is an employee of AstraZeneca. Giorgio Walter Canonica has previously received grant or research support from Boehringer Ingelheim, ALK-Abelló, and Stallergenes and honoraria or consultation fees from Menarini, GlaxoSmithKline, Sanofi, Teva, Hal, AstraZeneca, and Novartis.

Figures

Fig. 1
Fig. 1
Annual cost of OCS-related adverse outcomes [33]
See this image and copyright information in PMC

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