Oral corticosteroids (OCS) are a common treatment for acute
asthma flare-ups. While the medication has been shown to reduce ED visits and
hospitalisations due to flare-ups, it may be used chronically in severe asthma
Short-term risks associated with OCS overexposure include
elevated eye pressure (glaucoma), fluid retention, high blood pressure, weight
gain and problems with mood, memory and behavior. Long-term risks include
cataracts, infections, osteoporosis, high blood sugar levels in patients with
diabetes, thin skin, bruising, and a slower healing process for wounds. While
OCS can be an important tool in managing asthma in certain cases, their use
should always be carefully monitored by an asthma specialist or a primary care
provider with expertise in asthma.
In recent years, new and innovative treatments have emerged,
targeting certain types of severe or difficult-to-control asthma in ways never
before possible and reducing chronic use of oral corticosteroids by severe
asthma patients. OCS are relatively inexpensive, fast-acting and easy for
patients to access; they remain attractive to payers, patients and other stakeholders
within the healthcare system. Without an organised approach to intervention, it
is believed that OCS overexposure will persist.
The American College of Allergy, Asthma and Immunology has
partnered with allergy and asthma patient advocacy groups, other medical
professional societies and industry stakeholders to raise awareness of OCS
stewardship and develop strategies to curb reliance on OCS.
The collaborative urges a systematic effort to curb OCS
Educating patients and their caregivers about the risks
associated with chronic or recurrent OCS use, the importance of adherence to
other asthma medicines, and advanced treatment options.
Ensuring that patients have access to qualified asthma
specialists or primary care providers with asthma expertise. These specialists
should be able to address adherence concerns, determine if a patient has a
severe, difficult-to-control form of asthma that might benefit from innovative
targeted treatments, and carefully monitor OCS use.
Supporting healthcare providers (allergists, pulmonologists
and primary care) to develop and adopt OCS-sparing strategies and practice
Urging government agencies to modernise public health
policies and materials to reflect the importance of OCS-sparing interventions.
Petitioning payers to adopt OCS-sparing strategies by
providing appropriate and timely access to conventional and advanced treatment
options based on the clinical judgement of the treating HCP in consultation
with the patient.
Ensuring primary and urgent/emergency care providers recognise
when to refer patients to an asthma specialist, or a primary care provider with
Empowering urgent/emergency care providers, asthma educators
and other health professionals to engage with patients about OCS risks at