Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study

Abstract

The study facilitator (C.M.S.) designed the study, developed the protocol and data collection tools, classified hundreds of raw brainstorming statements, organized survey logistics, collected and analyzed the data, and wrote the report. The steering committee (A.M.-G., D.P., E.R.B., G.W.C., M.G., and A.B.) provided initial recommendations of experts invited to enroll in the study and provided guidance to C.M.S. on study design, data collection, survey logistics, data analysis, and report writing. Expert panel members who contributed complete questionnaires to the study are listed in the online supplement. All authors participated in the Funding: This study was funded by an unrestricted grant obtained through an investigatordriven submission to the AstraZeneca Cybergrant portal for educational programs. This research was conducted entirely independently of the funder, who had no role in the study design, data collection, analysis, or interpretation/write-up of the study report or manuscript. Medical writing support was funded via the unrestricted grant.

Contemporary Concise Review 2020: Asthma

“…A schematic algorithm for tapering OCS was produced and is presented in Figure 3. 21 The European Respiratory Society/American Thoracic Society guideline on the management of severe asthma was also published. 25 The guideline authors conducted systematic reviews of the evidence to provide recommendations on the efficacy of mAb therapies, macrolide antibiotics and long-acting muscarinic agents.…”

“…This issue of OCS stewardship was certainly topical throughout 2020, with several publications addressing the use of OCS in asthma, the need to minimize their use and efficacious strategies to do so 18,21–24 . Suehs et al reported a modified Delphi survey which was conducted to develop expert consensus statements on the use of OCS, specifically relating to tapering of treatment, adverse effects, patient–physician shared decision‐making and adrenal insufficiency.…”

“…The panel of 131 international experts achieved consensus on appropriate use of OCS, on tapering of treatment, adverse effects and on shared decision‐making. A schematic algorithm for tapering OCS was produced and is presented in Figure 3 21 …”

MIA 2021, Manejo Integral del Asma. Lineamientos para México

“…Un panel de expertos consideró una dosis diaria de 5 mg o 500 mg anual aceptable o eventualmente una dosis de 10 mg con máximo 1 g anual. 50 No parece apropiado reducir o suspender el CSO en pacientes con granulomatosis eosinofílica con poliangeítis o con aspergilosis broncopulmonar alérgica, que recaen al reducirlo, en aquellos con intentos previos fallidos de destete de los CSO o en aquellos con insuficiencia suprarrenal. 50 El panel de expertos desarrolló un algoritmo de cómo se podría proceder con la reducción del CSO, con la velocidad de reducción dependiendo de la dosis de mantenimiento del CSO.…”

“…Se puede encontrar en la publicación original y en el anexo 7. 50 Damos una sugerencia de cómo llevar el abordaje, siempre individualizando: progresivamente. III.…”