Asthma

High doses of oral steroids in asthma revealed


Almost a third of patients with severe asthma are taking potentially harmful doses of oral steroids, according to a Dutch study presented at the 2019 ERS Congress.

The study used a pharmacy database of more than 500,000 Dutch residents to identify patients with severe asthma – those using high doses of inhaled corticosteroids plus long-acting beta agonists.

The database also included information on oral corticosteroids and adherence to medication.

Dr Katrien Eger, a PhD candidate and pulmonologist in training at the Amsterdam University Medical Centre, told the Congress that 29% of asthma patients using ICS/LABA combinations were also using oral steroids at doses ≥420 mg.

The median dose was 750 mg/year – the equivalent of about four rescue doses.

The study found about 78% of high oral corticosteroid users either had suboptimal adherence or suboptimal inhalation technique – providing scope to reduce their reliance on oral corticosteroids.

However beyond that, 21.9% of patients who still required oral corticosteroids to control their asthma could be given a trial of biologic therapy.

Dr Eger said that in extrapolating from their database to the general Dutch population, about 6,000 patients with severe asthma were candidates for biologics yet fewer than half were receiving them.

“This shows that there is the potential to substantially reduce oral steroid overuse,” she said.

Although they were expensive medications, identifying and treating patients who could benefit from them would have economic benefits.

Savings would come by reducing the healthcare costs associated with adverse effects of oral steroids as well as through less absenteeism and improved productivity.

Speaking in the same session, Professor Christina Domingo Ribas from the Hospital de Sabadell and Autonomous University of Barcelona, said an open, randomised study of omalizumab had demonstrated the oral corticosteroid-sparing effect of the biologic in adults with allergic asthma.

Patients determined to be oral steroid dependent who received omalizumab were able to reduce their steroid dose by 73.5% compared to other steroid dependent patients.

Exacerbations also decreased by 41% in the biologic treated group.

Histology was able to show a corresponding reduction in inflammation with increasing appearance of cilia, a reduction in basement membrane thickness and reduced intercellular space.

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