Oral Corticosteroid Use in Asthma: Recognizing the Risks and Reducing Overuse

Content from the Michigan Department of Health and Human Services

Do your patients overuse oral corticosteroids (OCS)? While OCS can be an important tool in managing asthma in certain cases, use should always be carefully monitored by a qualified asthma specialist, or a primary care provider with asthma expertise. OCS carry serious health risks – just four bursts of steroids or 1–2.5 grams of OCS over a lifetime can increase a patient’s risk for serious side effects. Even short-term, low-dose use of OCS (under 30 days) can result in serious health problems, doubling the risk for fracture, tripling the risk for blood clots, and increasing sepsis risk fivefold. Other long-term effects include cataracts, high blood sugar (which can trigger or worsen diabetes), infections, osteoporosis and thin skin, bruising, and slower wound healing.

OCS use is a signal that a patient may need an updated treatment plan or additional support with medication adherence. Conventional medications often include inhaled corticosteroids (ICS), which result in much lower overall steroid exposure than even one course of OCS.

What can you do to help prevent OCS overuse? Educate your patients and their caregivers about:

• The risks associated with OCS, as even a brief discussion can help patients understand the possible dangers of short- and long-term use.
• The importance of adherence to other asthma medicines, emphasizing daily use of ICS even when symptoms are not present to help prevent severe flare-ups that require OCS. Single Maintenance and Reliever Therapy (SMART) uses a single inhaler containing both an ICS and a quick-relief medication (formoterol) for daily maintenance and symptom relief.
• Advanced treatment options, including biologic medications for moderate-to-severe asthma that is not well controlled with standard inhalers. These therapies can reduce symptoms, hospital visits, and the need for oral steroids.

Sometimes these conversations are hard to start, and patients may want a “quick fix” for their symptoms. These resources can help:

• OCS Overexposed Conversation Starter
• Inspiring Health Advances in Lung Care (INHALE) OCS Toolkit
• SABA/OCS Overuse Infographic
• Video: Is It Time to Embrace Oral Corticosteroid (OCS) Stewardship in Asthma and COPD Care?