Systematic Literature Review of Systemic Corticosteroid Use for Asthma Management

Systemic corticosteroid use to manage uncontrolled asthma and its associated health care 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 from 2010-2017, using search terms for asthma with key words for oral corticosteroids and systemic corticosteroids. Observational studies, prescription database analyses, economic analyses, and surveys on oral/systemic corticosteroid use for children (aged >5 years), adolescents (aged 12-17 years), 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 corticosteroid use was common in asthma management and more frequent for patients with severe asthma compared with patients 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 increased risk of acute and chronic adverse events (AEs), even when doses were comparatively low. Greater oral/systemic corticosteroid exposure was also associated with increased costs and health care resource utilization. This review provides a comprehensive overview of oral/systemic corticosteroid use and associated AEs for patients with all degrees of asthma severity and exposure duration. We report that oral/systemic corticosteroid use is prevalent in asthma management, and risks of acute and chronic complications increase with cumulative OCS dosage.