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Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand

Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to intr...

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Autores principales: Blakey, John, Chung, Li Ping, McDonald, Vanessa M., Ruane, Laurence, Gornall, John, Barton, Chris, Bosnic‐Anticevich, Sinthia, Harrington, John, Hew, Mark, Holland, Anne E., Hopkins, Trudy, Jayaram, Lata, Reddel, Helen, Upham, John W., Gibson, Peter G., Bardin, Philip
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291960/
https://www.ncbi.nlm.nih.gov/pubmed/34587348
http://dx.doi.org/10.1111/resp.14147
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author Blakey, John
Chung, Li Ping
McDonald, Vanessa M.
Ruane, Laurence
Gornall, John
Barton, Chris
Bosnic‐Anticevich, Sinthia
Harrington, John
Hew, Mark
Holland, Anne E.
Hopkins, Trudy
Jayaram, Lata
Reddel, Helen
Upham, John W.
Gibson, Peter G.
Bardin, Philip
author_facet Blakey, John
Chung, Li Ping
McDonald, Vanessa M.
Ruane, Laurence
Gornall, John
Barton, Chris
Bosnic‐Anticevich, Sinthia
Harrington, John
Hew, Mark
Holland, Anne E.
Hopkins, Trudy
Jayaram, Lata
Reddel, Helen
Upham, John W.
Gibson, Peter G.
Bardin, Philip
author_sort Blakey, John
collection PubMed
description Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to introduce OCS stewardship approaches, akin to successful initiatives that optimized appropriate antibiotic usage. The aim of this TSANZ (Thoracic Society of Australia and New Zealand) position paper is to review current knowledge pertaining to OCS use in asthma and then delineate principles of OCS stewardship. Recent evidence indicates overuse and over‐reliance on OCS for asthma and that doses >1000 mg prednisolone‐equivalent cumulatively are likely to have serious side effects and adverse outcomes. Patient perspectives emphasize the detrimental impacts of OCS‐related side effects such as weight gain, insomnia, mood disturbances and skin changes. Improvements in asthma control and prevention of exacerbations can be achieved by improved inhaler technique, adherence to therapy, asthma education, smoking cessation, multidisciplinary review, optimized medications and other strategies. Recently, add‐on therapies including novel biological agents and macrolide antibiotics have demonstrated reductions in OCS requirements. Harm reduction may also be achieved through identification and mitigation of predictable adverse effects. OCS stewardship should entail greater awareness of appropriate indications for OCS prescription, risk–benefits of OCS medications, side effects, effective add‐on therapies and multidisciplinary review. If implemented, OCS stewardship can ensure that clinicians and patients with asthma are aware that OCS should not be used lightly, while providing reassurance that asthma can be controlled in most people without frequent use of OCS.
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spelling pubmed-92919602022-07-20 Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand Blakey, John Chung, Li Ping McDonald, Vanessa M. Ruane, Laurence Gornall, John Barton, Chris Bosnic‐Anticevich, Sinthia Harrington, John Hew, Mark Holland, Anne E. Hopkins, Trudy Jayaram, Lata Reddel, Helen Upham, John W. Gibson, Peter G. Bardin, Philip Respirology Position Statement Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to introduce OCS stewardship approaches, akin to successful initiatives that optimized appropriate antibiotic usage. The aim of this TSANZ (Thoracic Society of Australia and New Zealand) position paper is to review current knowledge pertaining to OCS use in asthma and then delineate principles of OCS stewardship. Recent evidence indicates overuse and over‐reliance on OCS for asthma and that doses >1000 mg prednisolone‐equivalent cumulatively are likely to have serious side effects and adverse outcomes. Patient perspectives emphasize the detrimental impacts of OCS‐related side effects such as weight gain, insomnia, mood disturbances and skin changes. Improvements in asthma control and prevention of exacerbations can be achieved by improved inhaler technique, adherence to therapy, asthma education, smoking cessation, multidisciplinary review, optimized medications and other strategies. Recently, add‐on therapies including novel biological agents and macrolide antibiotics have demonstrated reductions in OCS requirements. Harm reduction may also be achieved through identification and mitigation of predictable adverse effects. OCS stewardship should entail greater awareness of appropriate indications for OCS prescription, risk–benefits of OCS medications, side effects, effective add‐on therapies and multidisciplinary review. If implemented, OCS stewardship can ensure that clinicians and patients with asthma are aware that OCS should not be used lightly, while providing reassurance that asthma can be controlled in most people without frequent use of OCS. John Wiley & Sons, Ltd 2021-09-29 2021-12 /pmc/articles/PMC9291960/ /pubmed/34587348 http://dx.doi.org/10.1111/resp.14147 Text en © 2021 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Position Statement
Blakey, John
Chung, Li Ping
McDonald, Vanessa M.
Ruane, Laurence
Gornall, John
Barton, Chris
Bosnic‐Anticevich, Sinthia
Harrington, John
Hew, Mark
Holland, Anne E.
Hopkins, Trudy
Jayaram, Lata
Reddel, Helen
Upham, John W.
Gibson, Peter G.
Bardin, Philip
Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
title Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
title_full Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
title_fullStr Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
title_full_unstemmed Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
title_short Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand
title_sort oral corticosteroids stewardship for asthma in adults and adolescents: a position paper from the thoracic society of australia and new zealand
topic Position Statement
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291960/
https://www.ncbi.nlm.nih.gov/pubmed/34587348
http://dx.doi.org/10.1111/resp.14147
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