Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

David Price* (Corresponding Author), Mario Castro, Arnaud Bourdin, Sebastian Fucile, Pablo Altman

*Corresponding author for this work

Research output: Contribution to journalReview article

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Abstract

Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequences of long-term use are widely recognised, there appears to be a perception in the medical community that short courses of SCS are safe. Limited but growing evidence in the literature suggests that even very brief dosing periods (3-7 days) of SCS are enough to cause significantly negative outcomes for patients. Short courses of SCS are associated with increased risk of adverse events including loss of bone density, hypertension and gastrointestinal ulcers/bleeds, in addition to serious impacts on mental health. Strategies to improve asthma control are recommended, including: 1) as-needed combination therapies in mild asthma; 2) risk factor reduction; 3) improving adherence/inhaler technique; 4) earlier initiation of add-on therapies; 5) use of biologics in appropriate patients; 6) development of new therapies to better control the disease; and 7) widespread education of the medical community. We propose that patients and primary care physicians should consider a cumulative SCS dose of 1 g per year as a highly relevant and easy-to-recall threshold.

Original languageEnglish
Article number190151
Number of pages8
JournalEuropean respiratory review : an official journal of the European Respiratory Society
Volume29
Issue number155
Early online date3 Apr 2020
DOIs
Publication statusPublished - 2020

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Keywords

  • Adrenal Cortex Hormones/adverse effects
  • Anti-Asthmatic Agents/adverse effects
  • Asthma/drug therapy
  • Humans
  • Morbidity
  • Risk Factors
  • Treatment Outcome
  • GLUCOCORTICOIDS
  • BONE-MINERAL DENSITY
  • CHILDREN
  • IMPACT
  • ORAL CORTICOSTEROIDS
  • OUTCOMES
  • APPROPRIATE USE

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