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Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequen...

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Detalles Bibliográficos
Autores principales: Price, David, Castro, Mario, Bourdin, Arnaud, Fucile, Sebastian, Altman, Pablo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488828/
https://www.ncbi.nlm.nih.gov/pubmed/32245768
http://dx.doi.org/10.1183/16000617.0151-2019
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author Price, David
Castro, Mario
Bourdin, Arnaud
Fucile, Sebastian
Altman, Pablo
author_facet Price, David
Castro, Mario
Bourdin, Arnaud
Fucile, Sebastian
Altman, Pablo
author_sort Price, David
collection PubMed
description Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequences of long-term use are widely recognised, there appears to be a perception in the medical community that short courses of SCS are safe. Limited but growing evidence in the literature suggests that even very brief dosing periods (3–7 days) of SCS are enough to cause significantly negative outcomes for patients. Short courses of SCS are associated with increased risk of adverse events including loss of bone density, hypertension and gastrointestinal ulcers/bleeds, in addition to serious impacts on mental health. Strategies to improve asthma control are recommended, including: 1) as-needed combination therapies in mild asthma; 2) risk factor reduction; 3) improving adherence/inhaler technique; 4) earlier initiation of add-on therapies; 5) use of biologics in appropriate patients; 6) development of new therapies to better control the disease; and 7) widespread education of the medical community. We propose that patients and primary care physicians should consider a cumulative SCS dose of 1 g per year as a highly relevant and easy-to-recall threshold.
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spelling pubmed-94888282022-11-14 Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety Price, David Castro, Mario Bourdin, Arnaud Fucile, Sebastian Altman, Pablo Eur Respir Rev Reviews Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequences of long-term use are widely recognised, there appears to be a perception in the medical community that short courses of SCS are safe. Limited but growing evidence in the literature suggests that even very brief dosing periods (3–7 days) of SCS are enough to cause significantly negative outcomes for patients. Short courses of SCS are associated with increased risk of adverse events including loss of bone density, hypertension and gastrointestinal ulcers/bleeds, in addition to serious impacts on mental health. Strategies to improve asthma control are recommended, including: 1) as-needed combination therapies in mild asthma; 2) risk factor reduction; 3) improving adherence/inhaler technique; 4) earlier initiation of add-on therapies; 5) use of biologics in appropriate patients; 6) development of new therapies to better control the disease; and 7) widespread education of the medical community. We propose that patients and primary care physicians should consider a cumulative SCS dose of 1 g per year as a highly relevant and easy-to-recall threshold. European Respiratory Society 2020-04-03 /pmc/articles/PMC9488828/ /pubmed/32245768 http://dx.doi.org/10.1183/16000617.0151-2019 Text en Copyright ©ERS 2020. https://creativecommons.org/licenses/by-nc/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
spellingShingle Reviews
Price, David
Castro, Mario
Bourdin, Arnaud
Fucile, Sebastian
Altman, Pablo
Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
title Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
title_full Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
title_fullStr Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
title_full_unstemmed Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
title_short Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
title_sort short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488828/
https://www.ncbi.nlm.nih.gov/pubmed/32245768
http://dx.doi.org/10.1183/16000617.0151-2019
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