Sood Vidushi, Rogers Linda, Khurana Sandhya
Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of Pulmonary, Critical Care and Sleep, Mount Sinai-National Jewish Respiratory Institute and Icahn School of Medicine at Mount Sinai, New York, NY.
Chest. 2021 Nov;160(5):1614-1623. doi: 10.1016/j.chest.2021.05.021. Epub 2021 May 19.
Oral corticosteroid (OCS) use in severe asthma remains all too common despite advances in asthma treatment. Use of OCS is associated with significant toxicity that can have a lasting adverse impact on a patient's overall health. Monoclonal antibodies have been developed that reduce both the rate of occurrence of OCS-treated exacerbations and the OCS requirements in patients with oral corticosteroid-dependent asthma. This article describes strategies to prevent and best manage endocrine complications associated with OCS use and provides guidance on OCS dose management after the introduction of steroid-sparing therapies. (1) We identify OCS-dependent patients and assess for comorbidities including bone health, glycemic control, and adrenal function; (2) we begin attempts at OCS dose optimization before or soon after introducing a steroid-sparing biologic therapy; (3) we taper OCS, using explicit criteria for asthma control; (4) we assess hypothalamic-pituitary-adrenal axis integrity once a physiologic dose of OCS is achieved to guide further the rate of OCS taper; and (5) we manage corticosteroid-related comorbidities as detailed in this article.
尽管哮喘治疗取得了进展，但口服糖皮质激素（OCS）在重度哮喘中的使用仍然非常普遍。OCS的使用与显著的毒性相关，可能对患者的整体健康产生持久的不利影响。已经开发出单克隆抗体，可降低口服糖皮质激素依赖型哮喘患者中OCS治疗的加重发生率和OCS需求量。本文描述了预防和最佳管理与OCS使用相关的内分泌并发症的策略，并提供了引入糖皮质激素节省疗法后OCS剂量管理的指导。（1）我们识别OCS依赖型患者，并评估包括骨骼健康、血糖控制和肾上腺功能在内的合并症；（2）在引入糖皮质激素节省生物疗法之前或之后不久，我们开始尝试优化OCS剂量；（3）我们使用明确的哮喘控制标准逐渐减少OCS用量；（4）一旦达到生理剂量的OCS，我们评估下丘脑-垂体-肾上腺轴的完整性，以进一步指导OCS减量的速度；（5）我们按照本文详述的方法管理与糖皮质激素相关的合并症。
