TY - JOUR T1 - Low dose oral corticosteroids in asthma associates with increased morbidity and mortality JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.03054-2021 SP - 2103054 AU - Inge Raadal Skov AU - Hanne Madsen AU - Daniel Pilsgaard Henriksen AU - Jacob Harbo Andersen AU - Anton Pottegård AU - Jesper Rømhild Davidsen Y1 - 2022/01/01 UR - http://erj.ersjournals.com/content/early/2022/02/03/13993003.03054-2021.abstract N2 - Long-term oral corticosteroid (OCS) treatment for severe asthma is known to cause significant adverse effects, but knowledge on effects of lower exposures in general asthma populations is limited. We aimed to explore this in a nationwide Danish asthma population.Users of asthma medication aged 18–45 were identified in the Danish nationwide registers during 1999–2018 and followed prospectively in an open cohort design. Incident OCS-users were matched 1:4 to non-users by propensity scores with replacement. Associations between OCS use and incident comorbidities were examined by Cox regression. Mortality rates, causes of death, and rates of unscheduled hospital visits were assessed.OCS-users (n 30,352) had, compared to non-users (n 121,408), an increased risk of all outcomes with evident dose-response relationships starting at cumulative doses of ≤500 mg (prednisolone equivalents). Hazard ratios ranged from 1.24 (95% CI 1.18–1.30) for fractures to 8.53 (95% CI 3.97–18.33) for adrenal insufficiency. Depression/anxiety had the highest incidence rate difference at 4.3 (95% CI 3.6–5.0) per 1000 person years. Asthma-specific mortality rates were generally low at 0.15 (95% CI 0.11–0.20) and 0.04 (95% CI 0.02–0.06) per 1000 person years for OCS-users and non-users, respectively. Mortality rates and unscheduled hospital visits increased with increasing OCS exposure.The study findings should be interpreted with their observational nature in mind. However, we found that even at low cumulative exposure, OCS use in asthma management was associated with increased risk of comorbidities, mortality, and unscheduled hospital visits. Effective strategies for optimising asthma control and reducing OCS use are pivotal in asthma management.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Declaration of interest: IRS reports grants paid to her institution from AstraZeneca, Teva, Novartis, the Odd Fellow Lodge of Haderslev Denmark, the Region of Southern Denmark, and the University of Southern Denmark; and personal fees for lectures from Roche, outside the submitted work. Anton Pottegård reports participation in research projects funded by Alcon, Almirall, Astellas, AstraZeneca, Boehringer-Ingelheim, Novo Nordisk, Servier and LEO Pharma, all regulator-mandated phase IV-studies, all with funds paid to the institution where he was employed (no personal fees) and with no relation to the work reported in this paper. JRD reports grants and personal fees for advisory board participation and lectures from Roche and Boehringer Ingelheim, and personal fees for lectures from Chiesi, outside the submitted work. HM, DPH and JHA have nothing to disclose. ER -