Healthcare Professionals

Oral corticosteroids (OCS) are often referred to as “wonder drugs,” but a growing body of evidence indicates there are potentially serious short- and long-term unintended side effects of OCS overexposure.1 As such, it is a priority to minimize patient exposure where appropriate. 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 prevention and treatment plan, or support with adherence.

By thinking beyond the burst, you can support your patients with uncontrolled or severe asthma and help ensure that OCS treatment is reserved for when truly needed. If you treat patients with uncontrolled or severe asthma, download this discussion tool to review potential signs your patient’s asthma management plan may have failed. It is also important to ask your patients whether they have seen another healthcare professional for their uncontrolled or severe asthma, and especially whether they have been prescribed OCS elsewhere or intravenous steroids in the hospital.

Signs of uncontrolled asthma

When treating patients with asthma, adherence to medication should be assessed and an updated treatment plan should be considered if the patient2-5:

  • 1 — Had more than two courses – or bursts – of OCS in a one-year period
  • 2 — Had one or more asthma flares requiring a call to 911, emergency room visit, urgent care visit or hospitalization in the past year
  • 3 — Used a quick-relief or rescue inhaler more than two times per week
  • 4 — Refilled a quick-relief or rescue inhaler more than two times per year
  • 5 — Awakens at night with asthma symptoms more than two times per month
  • 6 — Struggles doing everyday activities like exercising, household chores or playing with children or grandchildren

Health risks associated with OCS

Even short-term low-dose use of OCS (less than 30 days) can result in serious health problems.1 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.6

Other health risks include1:

  • Elevated eye pressure (glaucoma)
  • Fluid retention (causing swelling in lower legs)
  • High blood pressure
  • Problems with mood, stress, memory and behavior
  • Weight gain (abdomen, face and neck)
  • Cataracts (clouded vision)
  • High blood sugar (can trigger or worsen diabetes)
  • Infections
  • Osteoporosis/
    bone fractures
  • Thin skin, bruising, slower wound healing
  • Suppressed adrenal gland production

*OCS should not be confused with inhaled corticosteroids (ICS).1

How Prevalent is OCS Overexposure?

A survey of people with asthma by the Asthma and Allergy Foundation of America (AAFA) found that nearly 85 percent of respondents used at least one course of OCS in the previous 12 months and 64 percent had done so two or more times.7 Patients who take two or more courses of OCS in a 12-month span may have poorly controlled asthma and should speak with a primary care provider with expertise in asthma or a qualified asthma specialist. Download the full survey results here.

Survey Results
References
  1. Mayo Clinic. Prednisone and other corticosteroids. Retrieved from https://www.mayoclinic.org/steroids/art-20045692.
  2. 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.
  3. Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol.2007;119(2):405-413.
  4. 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.
  5. 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.
  6. 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.
  7. Polling conducted by the Asthma and Allergy Foundation of America, May – June 2018.

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