Home > ORAL CORTICOSTEROID STEWARDSHIP STATEMENT

It is time to protect patients with asthma from potential overexposure to oral corticosteroids (OCS) – and to recognize OCS overuse for what it often is: a treatment plan failure.

OCS carry serious health risks (page 2). Innovative treatment options target certain types of severe or difficult-to-control asthma in ways never-before possible, reducing the need for OCS. Today, OCS use has become a signal that a patient may need an updated treatment plan, or support with adherence concerns. While OCS can be an important tool in managing asthma in certain cases, use should always be carefully monitored by a qualified asthma specialist, or a primary care provider with asthma expertise. NOTE: OCS should not be confused with ICS (inhaled corticosteroids), which have fewer risks (page 2).

Within this context, we, the undersigned, are embarking upon a collaborative, systematic effort to curb OCS overexposure by:

  1. Educating patients and their caregivers about (1) the risks associated with OCS; (2) the importance of adherence to other asthma medicines; and (3) advanced treatment options.
  2. Ensuring that patients have access to qualified asthma specialists, or primary care providers with asthma expertise, who can (1) address adherence concerns; (2) determine if a patient has a severe, difficult-to-control form of asthma that might benefit from innovative targeted treatments; and (3) carefully monitor OCS use.
  3. Supporting healthcare providers (allergists, pulmonologists, and primary care) to develop and adopt OCS- sparing strategies and practice shared decision-making.
  4. Urging government agencies to modernize public health policies and materials to reflect the importance of OCS-sparing interventions.
  5. Petitioning payers to adopt OCS-sparing strategies by providing appropriate and timely access to conventional and advanced treatment options based on the clinical judgment of the treating HCP in consultation with the patient.
  6. Ensuring primary and urgent / emergency care providers recognize when to refer patients to an asthma specialist, or a primary care provider with asthma expertise.
  7. Empowering urgent / emergency care providers, pharmacists, asthma educators, and other health professionals to engage with patients about OCS risks at point-of-care.

PATIENT INSIGHTS5
A recent survey of 519 adults with asthma found that:

  • Nearly 85% used at least one burst of OCS in the past 12 months.
  • 64% had done so two or more times.
  • About 20% did not equate >2 bursts of OCS (in a 12-month period) with poor asthma control or asthma severity.
  • 78% of those who currently see an asthma specialist had received an OCS Rx from someone other than their specialist.
  • 70% of those who currently see an asthma specialist report their doctor has talked to them about the risks/side effects associated with the overuse of OCS.
  • Over half of patients surveyed were not aware of other innovative treatments options for severe or hard-to-control asthma.* Polling conducted by the Asthma and Allergy Foundation of America, June 2018.

ABOUT ASTHMA

Asthma is a chronic lung condition affecting 26.5 million Americans.4 Five to ten percent of the total asthma population are believed to have severe asthma.1

Asthma causes coughing, wheezing, chest tightness, and shortness of breath. 1,12 Severe or difficult-to-control asthma can be debilitating to patients, negatively impacting their lives at home and at school or work.5,12Sudden severe symptoms can be fatal. 12

There is no cure for asthma, but a range of conventional and advanced medications can help control symptoms. When conventional medicines do not work despite proper adherence and administration technique, it can be an indicator of a severe or difficult-to-control type of asthma.1,2,6

OCS Health RisksEven short-term low-dose use of OCS (under 30 days) can result in serious health problems. One 2017 study* revealed that U.S. patients using OCS short-term doubled their risk for fracture, tripled it for blood clots, and had a fivefold increased risk for sepsis.9 *Study was not solely focused on patients using OCS to manage asthma.Other OCS Risks include:3,10,11Short-term:Elevated eye pressure (glaucoma)Fluid retention (causing swelling in lowerlegs)High blood pressureProblems with mood, memory, andbehaviorWeight gain (abdomen, face, and neck)Longer-term:Cataracts (clouded vision)High blood sugar (can trigger or worsendiabetes)InfectionsOsteoporosisThin skin, bruising, slower wound healing
INHALED VS. ORAL CORTICOSTEROIDSConventional medications often include inhaled corticosteroids, which are not the same as OCS and result in much lower overall steroid exposure than even one course of OCS.

INDICATORS OF UNCONTROLLED ASTHMA1,6,7,8

  1. Requiring more than two courses – or bursts – ofOCS in a 12-month period.
  2. One or more asthma episodes requiring a call to911, emergency room visit, or hospitalization inthe past 12 months.
  3. Use of quick-relief inhaler more than two timesper week.
  4. Refilling a quick-relief inhaler more than twotimes a year.
  5. Limitations doing everyday activities likeexercising or household chores.

TRANSPARENCY STATEMENT

The following organizations served as thought partners in the assembly of this statement:

SOURCES

1.Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373.
2.Lang DM. Severe asthma: epidemiology, burden of illness, and heterogeneity. Allergy Asthma Proc. 2015;36(6):418-424.
3.Humbert M, Busse W, Hanania NA. Controversies and opportunities in severe asthma. Curr Opin Pulm Med. 2018;24(1):83-93.
4.Centers for Disease Control and Prevention. (2017). National Centers for Health Statistics / Asthma.Retrieved from https://www.cdc.gov/nchs/fastats/asthma.htm.
5.Polling conducted by the Asthma and Allergy Foundation of America, May – June 2018.
6.Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by theNational Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol. 2007;119(2):405-413.
7.Millard, M, Hart M, Barnes, S. Validation of Rules of Two as a paradigm for assessing asthma control. Proc (Bayl Univ Med Cent). 2014 Apr; 27(2):79-82.
8.Hyland, ME, Whalley, B, Jones, RC, Masoli, M. A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales. Qual Life Res. 2015; 24:631-639.
9.Waljee AK, Rogers MAM, Lin P, Singal AG, Stein JD, Marks RM, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415.10
11.Prednisone and other corticosteroids. (2015, November 26). Retrieved from
12.Bateman JRM, Clarke SW. Sudden Death in Asthma. Thorax 1979; 34:40-44. Sarnes E, Crofford L, Watson M, Dennis G, Kan H, Bass D. Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. Clin Ther. 2011;33:1413-32.