Page 14 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 1
composing a category known as patients with severe refractory asthma [14-19]. For these patients it is necessary to consider additional treatment options, such as targeted treatment with monoclonal antibodies [20;21], endoscopic interventional therapy [22;23] or low maintenance doses of oral glucocorticoids (OCS) [1]. The choice of treatment will depend on the asthma phenotype (combination of clinical, physiological and inflammatory features) and local conditions such as the social-economic situation and the expertise of the treating physician.
Patients with glucocorticoid-depend severe asthma are patients who, despite the use of high intensity inhalation treatment for asthma, also require oral glucocorticoids to achieve an acceptable level of asthma control [15;24;25].
It is recommended that the duration of treatment with systemic glucocorticoids be kept as short as possible in order to avoid the adverse effects, but in some cases this is not feasible. The three most common situations that make patients with severe asthma dependent on systemic glucocorticoids are the following:
1) Patients who, after a burst of oral glucocorticoids for an asthma exacerbation, have entered a long-term step-down strategy to prevent a flair-up of the disease.
2) Patients with recurrent exacerbations of asthma despite high dose maintenance treatment with inhaled corticosteroids, and thus subject to short but frequent courses of oral glucocorticoids.
3) Patients with chronic uncontrolled symptoms, already on a maintenance dose of oral corticosteroids but requiring higher doses to maintain control [15;26;27].
In all these cases, patients are exposed to the cumulative adverse effects of systemic glucocorticoids, which places them in a category of patients with high complexity and needs. For these patients a close and personal management is mandatory in order to keep the balance between control of asthma and the minimum effective dose of medication.
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