PRS43 Reducing ORAL Corticosteroids in Severe Asthma (ROSA PROJECT): A Nationwide Portuguese Consensus

Abstract

We aimed to build a national consensus towards the optimization for the use of oral corticosteroids (OCS) in severe asthma. A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy in asthma; therapeutic schemes of systemic corticotherapy in crisis and maintenance; asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-‘strongly disagree’ to 5-‘strongly agree’). Consensus threshold was established as a percentage of agreement among participants equal or greater to 90% in the first round; and equal or greater to 85% in the second and third rounds. The level of consensus achieved by the panelist was discussed with all the participants in a face-to-face meeting. Forty-eight physicians (specialists in allergology and pulmonology) participated the study (final compliance rate of 95.8%). In the first round, consensus was reached on 28 items (43.1%), all due agreement. In the second round and thirds rounds, 15/37 (68.2%) and 10/22 items (45.5%) reached consensus, respectively. Twelve statements did not reach consensus. Overall, 87% of physicians agree that further actions, particularly with general practitioners, for the assessment of the cumulative risk of OCS in acute asthma exacerbations are needed. The vast majority of experts (91.7%) demonstrated a favorable perception for using biologic agents whenever patients are eligible. Most participants (95.8%) are intent to better accept measures of lung function deterioration compared to other outcomes (e.g. worsening of symptoms, quality of life). Monitoring patients’ comorbidities secondary to OCS side effects was rated as imperative by all experts. Our results can guide an update on asthma management in Portugal and should be supplemented by additional studies on therapy access, patients’ adherence, and costs.