Corticosteroids In Severe Asthma Research Articles

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

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.

Reducing oral corticosteroids in severe asthma (ROSA Project): a nationwide Portuguese consensus

Introduction and objectivesWe aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. Material and methodsA modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-‘strongly disagree’; 5-‘strongly agree’). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). ResultsForty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients’ comorbidities was rated as imperative by all experts. Conclusions: These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients’ adherence, and costs.

Targeted management of severe asthma: Developing a Canadian approach

Although only 5–10% of patients with asthma have severe disease, they account for a disproportionate share of the overall disease burden. Severe asthma is responsible for approximately 50% of all direct asthma-related costs as well as a significant decline in patient quality of life. For such patients, biologic or targeted therapies may be highly effective. However, their role is not widely understood and their use is currently minimal. Both Canadian and international research suggests that the adverse effects of oral corticosteroids in severe asthma are significant and costly but under-recognized. Our review of management of severe asthma in Canada highlights the need for increased recognition of the adverse effects of oral corticosteroids and more awareness of the newer alternative therapies on the part of physicians, as well as access to specialized care for the population with severe asthma including patient education resources, and ongoing monitoring with a severe asthma registry.

Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma.

Systemic/oral corticosteroids (OCS) have been used for decades in the management of acute asthma exacerbations and chronically in patients with uncontrolled severe asthma. However, while OCS are effective at treating acute exacerbations, there is only empirical evidence regarding the efficacy of OCS at reducing the rate of exacerbations. Evidence, although scarce, is suggestive of high exacerbation rates in severe asthma patients even when receiving maintenance treatment with OCS. In addition, use of OCS is associated with undesirable effects. Despite all this, physicians have continued to use OCS for managing severe asthma and acute exacerbation due to the lack of availability of effective alternatives. Fortunately, in the last decade several biologics have been proven safe and effective for patients with uncontrolled severe asthma. This has led to the Global Initiative for Asthma (GINA) recommending the use of biologics, instead of maintenance OCS, in patients with severe asthma (GINA Step 5). These include one biologic targeting immunoglobulin E (IgE) (omalizumab), and different biologics targeting interleukin-5 (IL-5), the IL-5 receptor (IL-5R) or IL-4 receptor α-unit (IL-4R α), including mepolizumab (subcutaneous), reslizumab (intravenous), benralizumab (subcutaneous) and dupilumab (subcutaneous). Omalizumab for the treatment of severe allergic asthma reduces exacerbations, irrespective of blood eosinophil levels. Anti-IL-5/IL-5R biologics are indicated in patients with severe eosinophilic asthma and repetitive exacerbations, irrespective of the presence or absence of allergy. Recently, an anti-IL4Rα biologic has been approved by the FDA for eosinophilic phenotype or oral corticosteroid-dependent asthma. Finally, physicians should consider using biologics as an alternative to chronic OCS therapy.

A perspective on systemic corticosteroid therapy in severe bronchial asthma in adults.

Systemic corticosteroids have been used in the treatment of asthma since 1950 and are still required for the treatment of acute severe asthma and corticosteroid dependent asthma. To provide an updated overview of clinical considerations of systemic corticosteroids use in severe adult bronchial asthma. PubMed searches were undertaken of studies published between 1950 and 2015. In this review the following concepts are discussed. 1) The onset of action of intravenous methylprednisone is 1-2 hours with a peak at 4-6 hours and duration of 12-30 hours. 2) Each patient should serve as their own control, using their best flow rates in the previous 6 months to 2 years. 3) The individual response to corticosteroid relates to the degree of obstruction at the time of onset of steroid treatment. 4) The pattern of response is variable but tends to be consistent for an individual patient. 5) In monitoring response to steroids frequent measures of peak expiratory flow rate and forced expiratory flow in 1 second are more useful than complete spirometric and lung mechanic tests measured less often. 6) In most cases oral steroids are as effective as parenteral regimens. 7) Patients usually respond in 3 days to 40 to 100 mg of methylprednisolone equivalent. 8) In corticosteroid resistant asthma consider compliance issues, allergen sensitivity, concomitant conditions, psychiatric factors and drug interactions. 9) Corticosteroid toxicity relates to the total lifetime dosage and serious side effects are usually not observed until a total dosage of 6.8 grams of prednisone equivalent. Until we have a better understanding of the mechanisms of action of glucocorticoids, we will continue to rely on currently available systemic corticosteroids in severe asthma. The intrapatient consistency as discussed in this review, should guide therapy.

Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial

Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial

Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial

Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial

Evaluation of the adrenal function in children age 0-48 months treated with high dose of inhaled corticosteroids for severe asthma

Evaluation of the adrenal function in children age 0-48 months treated with high dose of inhaled corticosteroids for severe asthma

Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial

BackgroundIn patients with prednisone-dependent asthma the dose of oral corticosteroids should be adjusted to the lowest possible level to reduce long-term adverse effects. However, the optimal strategy for tapering oral...

IV corticosteroids in severe asthma - the controversy continues

IV corticosteroids in severe asthma - the controversy continues

Outcome of Pregnancy in Women Requiring Corticosteroids for Severe Asthma

We report on the outcome of 56 pregnancies in 51 women with severe asthma requiring prednisone and/or beclomethasone dipropionate. There were no malformations, neonatal deaths, or maternal deaths. The overall incidence of premature (

Points from Letters: High-dose corticosteroids in severe asthma

Points from Letters: High-dose corticosteroids in severe asthma