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Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature

Timm Volmer, Timo Effenberger, Christoph Trautner, Roland Buhl
European Respiratory Journal 2018 52: 1800703; DOI: 10.1183/13993003.00703-2018
Timm Volmer
Smartstep Data Institute, Smartstep Consulting GmbH, Hamburg, Germany
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Timo Effenberger
SmartStep Consulting GmbH, Hamburg, Germany
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Christoph Trautner
Medicine Science Consulting, Berlin, Germany
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Roland Buhl
Mainz University Hospital, Pulmonary Dept, Mainz, Germany
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Abstract

This review provides an overview of the role of long-term treatment of severe asthma with oral corticosteroids (OCS) and its associated side-effects in adults. It is based on a systematic literature search conducted in MEDLINE, Embase and the Cochrane Library to identify relevant studies. After a short overview of severe asthma and its treatment we present studies showing a dose–response relationship in asthmatic patients treated with OCS and then consider by organ systems the undesired effects demonstrated in clinical and epidemiological studies in patients with OCS-dependent asthma. It was found that the risk of developing various OCS-related complications, including infections, diabetes and osteoporosis as well as psychiatric disorders, was higher for patients with long-term exposure to OCS compared with control groups. In addition, studies showed a significant increase in healthcare resource utilisation due to OCS treatment. Therefore, it is incumbent on every clinician to carefully weigh the potential benefit of preventing loss of asthma control against this risk before opting to prescribe long-term OCS therapy. Effective corticosteroid-sparing strategies must be used and should aim at short-term use with the lowest effective dose and start tapering as soon as possible until OCS therapy is terminated.

Abstract

Although oral corticosteroids are effective, due to side-effects corticosteroid-sparing strategies must be used and one should aim at short-term use with the lowest effective dose and start tapering as soon as possible until OCS therapy is terminated http://ow.ly/F8wU30ltEXc

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Conflict of interest: T. Volmer reports grants from Teva Pharmaceutical Industries Ltd, during the conduct of the study; and personal fees for consultancy from Teva Pharmaceutical Industries Ltd, outside the submitted work.

  • Conflict of interest: T. Effenberger reports grants from Teva Pharmaceutical Industries Ltd, during the conduct of the study; and personal fees for consultancy from Teva Pharmaceutical Industries Ltd, outside the submitted work.

  • Conflict of interest: C. Trautner reports grants from Teva Pharmaceutical Industries Ltd, during the conduct of the study; and personal fees for consultancy from Teva Pharmaceutical Industries Ltd, outside the submitted work.

  • Conflict of interest: R. Buhl reports grants from Teva Pharmaceutical Industries Ltd, during the conduct of the study; and personal fees for consultancy from Teva Pharmaceutical Industries Ltd, outside the submitted work.

  • Support statement: This research was partly funded through a restricted grant from Teva. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received April 13, 2018.
  • Accepted August 13, 2018.
  • Copyright ©ERS 2018
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Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature
Timm Volmer, Timo Effenberger, Christoph Trautner, Roland Buhl
European Respiratory Journal Oct 2018, 52 (4) 1800703; DOI: 10.1183/13993003.00703-2018

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Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature
Timm Volmer, Timo Effenberger, Christoph Trautner, Roland Buhl
European Respiratory Journal Oct 2018, 52 (4) 1800703; DOI: 10.1183/13993003.00703-2018
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