Page 37 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 37
llenges of Systemic Glucocorticoids Taper 2.2
in the Treatment of Severe Asthma
Sabina Škrgat1,2, Peter Kopač,3 Natalija Edelbaher4 and Tomaž Kocjan2,5
Abstract 1 Department of Pulmonary
Asthma is a chronic airway inflammatory disease, characterized by reversible airway obstruc- Diseases and Allergy, University
tion and airway hyperresponsiveness. It affects 1-18% of population in different countries and Medical Centre Ljubljana,
approximately 5–10% of the overall asthma population has severe asthma. Systemic gluco- Ljubljana, Slovenia
corticoids still represent a significant burden due to treatment of asthma exacerbations and
severe forms of asthma. Monoclonal antibodies are powerful anti-inflammatory agents with 2 Faculty of Medicine, University
glucocorticoid-sparing properties. With the increasing use of biologics, tapering and cessation of Ljubljana, Slovenia
of maintenance systemic glucocorticoids have become much more common. Personalized ap-
proach to tapering and careful assessment for adrenal insufficiency in all patients are recom- 3 University Clinic of Respiratory
mended by the experts. and Allergic Diseases, Golnik,
Slovenia
Keywords: severe asthma, glucocorticoids, side effects, adrenal insufficiency
4 Department of Pulmonary
Diseases, University Medical
Centre Maribor, Maribor, Slovenia
5 Department of Endocrinology,
Diabetes and Metabolic Diseases,
University Medical Centre
Ljubljana, Ljubljana, Slovenia
Introduction treatment of asthma exacerbations and of se-
vere asthma4,6.
Asthma is a chronic airway inflammatory dis-
The many systemic effects associated
ease, characterized by reversible airway ob- with long-term systemic GC use have been
struction and airway hyperresponsiveness1. It well studied and described7. The most com-
mon serious systemic GC-associated comor-
affects 1-18% of population in different coun- bidities include osteoporotic fractures, dia-
tries2. Approximately 5–10% of the patients betes, obesity, cardiovascular disorders, and
have severe asthma3, which remains uncon- hypothalamic-pituitary-adrenal (HPA) axis
suppression. In addition, use of systemic GC
trolled despite adherence to maximal opti- has been associated with psychiatric symp-
toms such as insomnia, mania, depression,
mized therapy and treatment of contributory anxiety, or aggressive behavior. Dyspepsia,
factors and comorbidities2. hypertension, dyslipidemia, opportunistic in-
fections, muscle atrophy, cataracts, glauco-
Systemic glucocorticoids (GC) became ma, bruising, cushingoid appearance, skin
striae and change in appetite can also oc-
available in 1956 and they have provided ef- cur5,8,9. Moreover, there is published evidence
fective treatment of asthma ever since4. Their suggesting that even brief (3–7 days), but re-
petitive courses of systemic GC can provoke
widespread use led to the recognition that
long-term systemic GC use is associated with
significant adverse events5 and to introduc-
tion of inhaled GC in 1972 as maintenance
treatment for asthma4. However, there is still
a significant burden of systemic GC due to
https://doi.org/10.26 493/978 -961-293 -157-5.37- 42
in the Treatment of Severe Asthma
Sabina Škrgat1,2, Peter Kopač,3 Natalija Edelbaher4 and Tomaž Kocjan2,5
Abstract 1 Department of Pulmonary
Asthma is a chronic airway inflammatory disease, characterized by reversible airway obstruc- Diseases and Allergy, University
tion and airway hyperresponsiveness. It affects 1-18% of population in different countries and Medical Centre Ljubljana,
approximately 5–10% of the overall asthma population has severe asthma. Systemic gluco- Ljubljana, Slovenia
corticoids still represent a significant burden due to treatment of asthma exacerbations and
severe forms of asthma. Monoclonal antibodies are powerful anti-inflammatory agents with 2 Faculty of Medicine, University
glucocorticoid-sparing properties. With the increasing use of biologics, tapering and cessation of Ljubljana, Slovenia
of maintenance systemic glucocorticoids have become much more common. Personalized ap-
proach to tapering and careful assessment for adrenal insufficiency in all patients are recom- 3 University Clinic of Respiratory
mended by the experts. and Allergic Diseases, Golnik,
Slovenia
Keywords: severe asthma, glucocorticoids, side effects, adrenal insufficiency
4 Department of Pulmonary
Diseases, University Medical
Centre Maribor, Maribor, Slovenia
5 Department of Endocrinology,
Diabetes and Metabolic Diseases,
University Medical Centre
Ljubljana, Ljubljana, Slovenia
Introduction treatment of asthma exacerbations and of se-
vere asthma4,6.
Asthma is a chronic airway inflammatory dis-
The many systemic effects associated
ease, characterized by reversible airway ob- with long-term systemic GC use have been
struction and airway hyperresponsiveness1. It well studied and described7. The most com-
mon serious systemic GC-associated comor-
affects 1-18% of population in different coun- bidities include osteoporotic fractures, dia-
tries2. Approximately 5–10% of the patients betes, obesity, cardiovascular disorders, and
have severe asthma3, which remains uncon- hypothalamic-pituitary-adrenal (HPA) axis
suppression. In addition, use of systemic GC
trolled despite adherence to maximal opti- has been associated with psychiatric symp-
toms such as insomnia, mania, depression,
mized therapy and treatment of contributory anxiety, or aggressive behavior. Dyspepsia,
factors and comorbidities2. hypertension, dyslipidemia, opportunistic in-
fections, muscle atrophy, cataracts, glauco-
Systemic glucocorticoids (GC) became ma, bruising, cushingoid appearance, skin
striae and change in appetite can also oc-
available in 1956 and they have provided ef- cur5,8,9. Moreover, there is published evidence
fective treatment of asthma ever since4. Their suggesting that even brief (3–7 days), but re-
petitive courses of systemic GC can provoke
widespread use led to the recognition that
long-term systemic GC use is associated with
significant adverse events5 and to introduc-
tion of inhaled GC in 1972 as maintenance
treatment for asthma4. However, there is still
a significant burden of systemic GC due to
https://doi.org/10.26 493/978 -961-293 -157-5.37- 42
