Canonica G Walter, Porsbjerg Celeste, Price David B, Wechsler Michael E, Heaney Liam G, Hanania Nicola A, Gall Rebecca, Pandit-Abid Nami, Jacob-Nara Juby A, Sacks Harry J
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Personalized Medicine Center: Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Allergy. 2025 Aug;80(8):2113-2127. doi: 10.1111/all.16569. Epub 2025 Jun 23.
Over the past 70 years, oral corticosteroids (OCS) have played an important role in the management of acute and chronic asthma; however, their use is associated with an increased incidence of adverse events, chronic diseases such as osteoporosis and diabetes, and mortality, as well as increased healthcare resource utilization and costs. Despite a consensus that the use of OCS should be minimized in asthma treatment strategies, many patients still routinely receive long-term or frequent short courses of OCS. Add-on biologics can help to improve asthma control in patients with severe asthma and evidence of type 2 inflammation; in clinical trials and real-world studies, both short- and long-term OCS-sparing effects have been demonstrated. In this review, we discuss the benefits and burdens of OCS in patients with severe asthma from the perspective of both patients and healthcare providers and outline potential methods for reducing reliance on OCS. Given the risk of adrenal insufficiency or crisis upon cessation of OCS, we discuss the need for clear guidance and algorithms for the tapering of OCS together with the requirement for multidisciplinary patient-provider interactions as part of an effective OCS stewardship scheme.
在过去70年里，口服糖皮质激素（OCS）在急性和慢性哮喘的管理中发挥了重要作用；然而，其使用与不良事件、骨质疏松症和糖尿病等慢性疾病、死亡率的发生率增加相关，还会导致医疗资源利用和成本增加。尽管人们一致认为在哮喘治疗策略中应尽量减少OCS的使用，但许多患者仍经常接受长期或频繁的短期OCS治疗。附加生物制剂有助于改善重度哮喘且有2型炎症证据患者的哮喘控制；在临床试验和真实世界研究中，均已证明其具有短期和长期的减少OCS使用的效果。在本综述中，我们从患者和医疗服务提供者的角度讨论了OCS在重度哮喘患者中的益处和负担，并概述了减少对OCS依赖的潜在方法。鉴于停用OCS会有肾上腺功能不全或危机的风险，我们讨论了制定明确的OCS减量指导和算法的必要性，以及作为有效OCS管理计划一部分的多学科患者与提供者互动的要求。
