From the Guidelines
Yes, oral corticosteroids can be prescribed long-term for severe asthma treatment, but this is typically done only in cases of severe, persistent asthma that does not respond adequately to other treatments. The most commonly used oral corticosteroid for long-term asthma management is prednisone, with a typical starting dose of 5-60 mg daily, depending on the severity of symptoms, as noted in the guidelines 1. The goal is to use the lowest effective dose to control symptoms and then taper down if possible.
Key Considerations
- Long-term use should be closely monitored by a healthcare provider due to potential side effects, which can include osteoporosis, weight gain, diabetes, and adrenal suppression, as highlighted in the expert panel report 1.
- Patients on long-term oral corticosteroids should have regular check-ups, bone density scans, and blood sugar monitoring.
- Before resorting to long-term oral corticosteroids, other treatments should be optimized, including high-dose inhaled corticosteroids, long-acting beta-agonists, and biologics (such as omalizumab or mepolizumab) if appropriate, as recommended in the guidelines 1.
- Oral corticosteroids work by reducing inflammation in the airways, which helps to alleviate asthma symptoms, but their systemic effects can lead to significant side effects when used long-term, which is why they are generally reserved for severe cases that don't respond to other treatments.
Monitoring and Adjustments
- Regular follow-up contact is essential to maintain control of asthma, with patient contact scheduled at 1-month to 6-month intervals, depending on factors such as the level or duration of asthma control and the level of treatment required, as suggested in the guidelines 1.
- A step down in therapy should be considered once asthma is well controlled for at least 3 months, with a gradual reduction in therapy and close monitoring, as recommended in the expert panel report 1.
Conclusion is not allowed, so the response ends here.
From the Research
Oral Corticosteroids for Severe Asthma Treatment
- Oral corticosteroids (OCS) can be prescribed for severe asthma treatment, but their long-term use is associated with various side-effects and complications 2, 3, 4, 5.
- Studies have shown that long-term exposure to OCS increases the risk of developing infections, diabetes, osteoporosis, and psychiatric disorders 2, 4, 5.
- The use of OCS should be carefully weighed against the potential benefits of preventing loss of asthma control, and effective corticosteroid-sparing strategies should be used to minimize long-term use 2, 5.
- Alternative treatments, such as biologics, have been shown to reduce the need for OCS in severe asthma and improve patient-related outcomes 5.
Considerations for Long-Term OCS Use
- Patients on long-term OCS therapy should be monitored for potential side-effects and comorbidities, and efforts should be made to minimize the dose and duration of treatment 2, 4, 5.
- The optimal dose and duration of OCS therapy for acute asthma exacerbations is still unclear, and further research is needed to determine the most effective and safe treatment regimens 6.
- Patient perceptions of OCS treatment benefits and risks can affect adherence to treatment, and healthcare providers should consider these factors when making treatment decisions 3.
Alternative Treatment Options
- Biologics, such as omalizumab, mepolizumab, benralizumab, and dupilumab, have been shown to reduce the need for OCS in severe asthma and improve patient-related outcomes 5.
- These alternative treatments may be considered for patients who are at risk of OCS-related side-effects or who have not responded to traditional treatments 5.