Burden of Oral Corticosteroid Use in Severe Asthma: Challenges and Opportunities

Over the past 70 years, oral corticosteroids (OCS) have played an important role in the management of acute and chronic asthma; however, their use is associated with an increased incidence of adverse events, chronic diseases such as osteoporosis and diabetes, and mortality, as well as increased healthcare resource utilization and costs. Despite a consensus that the use of OCS should be minimized in asthma treatment strategies, many patients still routinely receive long-term or frequent short courses of OCS. Add-on biologics can help to improve asthma control in patients with severe asthma and evidence of type 2 inflammation; in clinical trials and real-world studies, both short- and long-term OCS-sparing effects have been demonstrated. In this review, we discuss the benefits and burdens of OCS in patients with severe asthma from the perspective of both patients and healthcare providers and outline potential methods for reducing reliance on OCS. Given the risk of adrenal insufficiency or crisis upon cessation of OCS, we discuss the need for clear guidance and algorithms for the tapering of OCS together with the requirement for multidisciplinary patient-provider interactions as part of an effective OCS stewardship scheme.