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Review
. 2023 Apr 3;16(4):100760.
doi: 10.1016/j.waojou.2023.100760. eCollection 2023 Apr.

The use of systemic corticosteroids in asthma management in Latin American countries

Jorge F Maspero  1 , Alvaro A Cruz  2 , Cesar Fireth Pozo Beltran  3 , Abraham Ali Munive  4 , Felicia Montero-Arias  5 , Ramses Hernandez Pliego  6 , Hisham Farouk  6
Affiliations
Review

The use of systemic corticosteroids in asthma management in Latin American countries

Jorge F Maspero et al. World Allergy Organ J. .

Abstract

The stepwise treatment approach recommended by the Global Initiative for Asthma (GINA) includes systemic corticosteroids (SCS) suggested as a final step if asthma is severe and/or difficult to treat. Yet, despite the effectiveness of SCS, they are also associated with potentially irreversible adverse outcomes such as type 2 diabetes, adrenal suppression, and cardiovascular disease. Based on recent data indicating that the risk of developing these conditions can increase after as few as 4 short-term (burst) courses of SCS, even patients with mild asthma who receive SCS occasionally for exacerbations are also at risk of these events. As a result, recent updates by GINA and the Latin American Thoracic Society recommend decreasing SCS use by optimizing administration of non-SCS therapies and/or increasing the use of alternatives, such as biologic agents. Recent and ongoing studies characterizing treatment patterns among patients with asthma have revealed alarming trends suggesting the widespread overuse of SCS around the world. In Latin America, asthma prevalence is approximately 17%, and data suggest that the majority of patients have uncontrolled disease. In this review, we summarize currently available data on asthma treatment patterns in Latin America, which indicate that SCS are prescribed to 20-40% of patients with asthma considered to be well controlled and over 50% of patients with uncontrolled disease. We also offer potential strategies to help reduce SCS use for asthma in everyday clinical practice.

Keywords: Adverse effects; Biological products; Latin America; Severe asthma; Systemic corticosteroids.

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Figures

Fig. 1
Fig. 1
GINA 2021 recommendations for personalized asthma management for adults and adolescents ≥12 years of age. HDM, house dust mite; ICS, inhaled corticosteroid; LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; OCS, oral corticosteroids; SABA, short-acting beta2-agonist; SLIT, sublingual immunotherapy. aStep 5 should also include referral for phenotypic assessment for anti-IgE, anti-IL5/5R, and/or anti-IL4R. bOCS should only be considered for adults with poor symptom control and/or frequent exacerbations despite good inhaler technique and adherence with Step 5 treatment and after exclusion of other contributory factors and other add-on treatments, including biologics where available and affordable.
Fig. 2
Fig. 2
Representative findings from real-world data showing associations between systemic corticosteroid (SCS) exposure and risk of adverse outcomes in patients with severe asthma. (A) Odds ratios for incidence of acute or chronic oral corticosteroid (OCS)−related adverse events stratified by OCS exposure between patients prescribed (n = 12,697) or not prescribed (n = 12,697) SCS for severe asthma between 2003 and 2014 in the US. Rates of complications were assessed quarterly for at least 6 months from the first daily dose of 5 mg or more of prednisone equivalent until the end of data availability. Adapted from Dalal et al. (B) Odds ratios for adverse events with significant increases in incidence between patients prescribed at least 4 OCS courses over a minimum 24-month period (n = 72,063) vs. patients not prescribed OCS (n = 72,063) from 2000 to 2014 in the US. Adapted from Sullivan et al. (C) Cumulative incidence of selected adverse events over time between patients treated (red line; n = 9142) and not treated (yellow line; n = 9142) with SCS for severe asthma between 1994 and 2015 in the UK. Adapted from Voorham et al. Acute complications: infections and gastrointestinal complications. Chronic complications: cardiovascular, metabolic, bone- and muscle-related, psychiatric, ocular, skin-related, adrenal, or other (bladder cancer, epistaxis, and non-Hodgkin's lymphoma).∗P < 0.05
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