Patients & Caregivers

Protect yourself, or your loved ones, with uncontrolled or severe asthma, from a failed treatment plan.

Overexposure to oral corticosteroids (OCS) carries serious health risks.1 To avoid unnecessary exposure to OCS, take a moment to think about whether your or your loved one’s asthma is uncontrolled before the next doctor visit. It is also important to review the written treatment plan given to you by your doctor and follow that plan every day to control your or your loved one’s asthma and avoid side effects. If you don’t have a written treatment plan, talk to your doctor to get one that works for you. If an OCS is given during a visit to urgent care or the emergency room, be sure to tell your doctor and schedule a follow-up visit.

common asthma “triggers”

There are also common asthma “triggers” which can be avoided to help control symptoms2:

  • Allergens (pollen, dust mites, cockroaches, mold,
    animal dander)
  • Smoke (including tobacco smoke), air pollution, strong odors, chemical fumes,
    exhaust fumes
  • Common pain relief medications like aspirin and ibuprofen
  • Extreme weather conditions
  • Exercise
  • Stress and strong emotions

Not every type of asthma is the same. With new, targeted treatment options available, even people living with severe asthma deserve to be free from frequent or severe symptoms. Reliance on OCS, either in frequent short bursts or for longer periods of time, can be a sign of poor control and should be discussed with your doctor.

What is OCS?

Oral corticosteroids are important medicines that are often used to treat asthma flares by reducing inflammation and swelling in the airways quickly.3 OCS should not be confused with inhaled corticosteroids (ICS) delivered by an inhaler, which are often used to treat asthma.1 Your doctor may use OCS in combination with short-acting beta agonists (also called bronchodilators or quick-relief/rescue inhalers), such as albuterol, a long-acting muscarinic antagonist (LAMA), or a combination of a long-acting beta agonist (LABA) and an ICS (which are both also called maintenance medications), such as tiotropium or fluticasone propionate/salmeterol.

Here are examples of OCS so you can recognize when one is prescribed by your doctor:
  • prednisone
  • prednisolone
  • methylprednisolone
  • dexamethasone

OCS Conversation Starter

If you have asthma, or care for someone with asthma, and might think or want to know if it is uncontrolled, download and complete this checklist before your next doctor visit. Having this conversation may help make sure the right treatment plan is in place. Speak to your doctor before making any changes to your treatment plan.

If you or your loved one has seen more than one healthcare professional for uncontrolled or severe asthma, be sure to tell your doctors about that too.

It is very important that you stay on your treatment plan and follow up with your doctor about any questions you have.

How do I know if asthma is uncontrolled?

Ask yourself whether you or your loved one4-7:

  • 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 — Wake at night with asthma symptoms more than two times per month
  • 6 — Struggled doing everyday activities like exercising, household chores or playing with children or grandchildren
  • These are all signs that asthma is uncontrolled. If you answered “Yes” to any of these, download the resource above and talk to a doctor if you or your loved one experienced any of these.
  • If you notice any of these signs, it is also important to ask yourself or your loved one if a treatment plan is really being followed closely. People may forget to take their medicine or don’t take their medicine as prescribed. It is also important to make sure the key problems that trigger asthma (e.g., tobacco smoke or pets) are avoided.
  • If you or your loved one is having a hard time following the treatment plan, talk to your doctor truthfully about the reason why. Doctors may be able to help make the plan easier to follow, which can cut the need for OCS and help with symptoms.

What are the risks
of OCS overexposure?

There are both short- and long-term risks of OCS overexposure.1

  • Elevated eye pressure (glaucoma)
  • Fluid retention
  • High blood pressure
  • Weight gain
  • Problems with mood, stress, memory and behavior
  • Cataracts
  • Infections
  • Osteoporosis (thinning of the bones which increases risk of broken bones and fractures)
  • High blood sugar (can cause or worsen diabetes)
  • Thin skin, bruising and a slower healing process for wounds
  • Adrenal insufficiency, which stops the body from making enough important hormones and can make it harder to manage stress or recover from infections

While OCS can be an important tool in managing asthma in certain cases, their use should always be carefully monitored by an asthma specialist or a primary care provider with expertise in asthma.

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

Why is OCS overexposure happening?
  • OCS overexposure can happen for a number of reasons. Ideally, a person living with asthma is seen by a primary care provider with expertise in asthma or an asthma specialist if their asthma is uncontrolled or severe. However, people often rely on other healthcare providers; instead, people may visit pharmacies, urgent care or the emergency room to manage their condition, especially if they aren’t feeling well and need to be seen right away. This can lead to several “bursts” of OCS in a relatively short period of time, because only the immediate need is treated. People may feel “well” between episodes where OCS were used, but that does not mean that their asthma is under control. Whether your condition is being managed by a primary care doctor or an asthma specialist, it is important to let your doctor know if you have received care or medication from another medical professional.

    Many patients and healthcare professionals have also come to rely on treatment with OCS because OCS work quickly and are very effective. Think about it like antibiotics. Years ago, doctors rarely prescribed antibiotics, but over time, it became common for people to demand an antibiotic every time they were sick. Eventually, people began to build a resistance to antibiotics, and the antibiotics did not work as well when the medicines were actually needed.8 A similar trend is happening with OCS, but rather than building up a resistance, there are actually serious short- and long-term risks associated with using OCS repeatedly.1 In addition to health risks, people with high OCS use have roughly twice the yearly annual healthcare costs compared to people with low OCS use.9

    Today, OCS use has become a sign that an updated treatment plan may be needed. There are new treatment options that target certain types of severe or difficult-to-control asthma in ways never before possible, reducing the need for OCS.

How common 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.10 Taking two or more courses of OCS in a 12-month span may mean they have severe or 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.

References
  1. Mayo Clinic. Prednisone and other corticosteroids. Retrieved from https://www.mayoclinic.org/steroids/art-20045692.
  2. American College of Allergy, Asthma & Immunology. Asthma Treatment. Retrieved from https://acaai.org/asthma/asthma-treatment.
  3. Asthma and Allergy Foundation of America. Oral Corticosteroids for Asthma. Retrieved from https://www.aafa.org/asthma-treatment-oral-corticosteroids-prednisone/.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. World Health Organization. Antibiotic resistance. Retrieved from https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance.
  9. Broder MS, Raimundo K, Ngai KM, Chang E, Grin NM, Heaney LG. Cost and health care utilization in patients with asthma and high oral corticosteroid use. Annals of Allergy, Asthma and Immunology,118(5), 638-639.
  10. Polling conducted by the Asthma and Allergy Foundation of America, May – June 2018.

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