Corticosteroid Stewardship: Can It Help Us Avoid the Corticosteroid Trap?

With an almost 20-year experience with asthma biologics, it is now clear that a major impact of all available asthma biologics is the opportunity to reduce the frequency of asthma exacerbations, along with the concomitant use of systemic corticosteroids. The asthma biologics allow for the reduction and occasionally discontinuation of maintenance systemic corticosteroids and permit reduction of high-dose inhaled corticosteroid dosing in patients with severe asthma. The risk of corticosteroid adverse effects in asthma has prompted experts to suggest that there be closer monitoring of corticosteroids and the term "corticosteroid stewardship" has emerged. This commentary will summarize advantages and limitations of developing a program for corticosteroid stewardship. There is an opportunity for asthma specialists to take a leadership position in developing a core stewardship program with elements including patient education materials and prototypes for shared decision-making approaches. Then, once this approach is refined, a more systematic approach within a health care system can evolve, especially with insurance providers as a partner. On one hand, corticosteroid stewardship could be viewed as adding extra burden. However, done correctly, it should be viewed as the way to go to enhance overall population asthma care within a health care system.