The burden of systemic corticosteroid use in asthma management in Asia

Abstract

For most patients, asthma can be effectively managed using inhaled medications. However, patients who have severe and/or uncontrolled asthma, or who experience exacerbations, may require systemic corticosteroids (SCSs) to maintain asthma control. Although SCS are highly effective in this regard, even modest exposure to these medications can increase the risk for long‐term, adverse health outcomes, such as type 2 diabetes, renal impairment, cardiovascular disease and overall mortality. Clinical and real‐world data from studies investigating asthma severity, control and treatment practices around the globe have suggested that SCS are overused in asthma management, adding to the already substantial healthcare burden experienced by patients. Throughout Asia, although data on asthma severity, control and SCS usage are limited and vary widely among countries, available data strongly suggest a pattern of overuse consistent with the broader global trend. Coordinated changes at the patient, provider, institutional and policy levels, such as increasing disease awareness, promoting better adherence to treatment guidelines and increasing availability of safe and effective alternatives to SCS, are likely necessary to reduce the SCS burden for patients with asthma in Asia.

Contemporary Concise Review 2023: Asthma

“…The compound has been particularly useful in respiratory diseases and data indicate that up to 50% of all prescriptions for OCS are made for this indication 41,42 . In severe asthma OCS are often highly effective and overuse in this group has been identified as being of key concern 43–45 . It has prompted calls for OCS Stewardship 34,46 with publication of a global first Position Statement by the Thoracic Society of Australia New Zealand (TSANZ) in Respirology 47 …”

“…Use of maintenance OCS can be stopped in 30%–50% of patients and burst OCS given during exacerbations can be reduced by up to 70% in real‐world studies 51,52 . Unfortunately, advantages of this relatively new approach through utilization of biologic agents has had limited application in many countries due to costs, inexperience of health care providers with biologic agents, restricted access to specialist care and ignorance of the long‐term detrimental effect of OCS 45,47 …”

Mechanisms of Bushenyiqi decoction in the treatment of asthma: an investigation based on network pharmacology with experimental validation

“…Furthermore, despite receiving high doses or systemic GC therapy, some patients continue to have uncontrolled asthma due to poor GC sensitivity. Non-compliance with medication and the heavy economic burden are also problems during GC utilization ( Djukanovic, 2002 ; Caramori et al, 2022 ; Dhar et al, 2023 ). As a result, there has been a persistent demand for alternative treatments to glucocorticoids among asthma patients ( Djukanovic, 2002 ).…”