Intermittent oral corticosteroids for asthma linked to adverse events

By Rebecca Jenkins

Even one-off prescriptions for oral corticosteroids (OCS) for asthma are linked to an increased risk of corticosteroid-related adverse events, a large cohort study finds.

Previous research had shown OCS for asthma were associated with an increased risk of adverse events, the study authors wrote in Thorax, but no other study had exclusively examined intermittent OCS prescribing. 

Using primary care medical records from two large UK databases, researchers analysed information from almost half a million patients with asthma who were aged 4 years and older and had received intermittent-only OCS. 

These patients, who had at least 12 months of clinical data before the index date, were matched 1:1 on sex, age and index date with patients with or without asthma who had never  been exposed to OCS.

Researchers found 41.7% of patients were given a one-off OCS prescription, with a one-off script associated with an hazard ratio (HR) of 1.19 for any OCS-related adverse event compared with non-OCS use.

The highest risk of any adverse outcome, with an HR of 1.41, was associated with the 31.6% of patients who were frequently prescribed OCS at some point during follow up, defined as receiving one or more prescriptions less than 90 days apart.

For the 26.8% of patients who received less frequent prescriptions, defined as one or more prescription given 90 days or more apart, the HR was 1.35 compared with non-OSC use. 

‘The highest risks of individual OCS-related adverse outcomes with increasingly frequent OCS were for pneumonia and sleep apnoea,’ the researchers noted.

‘Our results suggest that the use of OCS, even intermittently, in the management of asthma should be minimised whenever possible.’

Professor Christine McDonald, Professor of Respiratory Medicine at the University of Melbourne, noted several guidelines recommended OCS for asthma exacerbations, and that patient initiation of OCS was encouraged if included in written asthma action plans.

‘In patients capable of self-management, self-treatment with a short course of OCS is effective at reducing relapse, need for additional care and required dose of beta agonists,’ Professor McDonald told Medicine Today.

‘However, their use as recommended is predicated on the appropriate use of preventive therapies. We know that in asthma management generally patients tend to underuse inhaled corticosteroids (ICS) and overuse short-acting beta agonists.’

Achieving better asthma management required a multifaceted approach, which included ensuring patients had clear explanation of the need for long-term therapy and reassurance about the benefits and risks of ICS and OCS.

‘This needs careful explanation and nuancing – for example, use one (ICS) regularly and judiciously to prevent the need for the other (which has less frequent but greater side effects),’ Professor McDonald said.

Thorax 2023; doi: 10.1136/thorax-2022-219642.