Page 16 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 1
There are also some post-transcriptional mechanisms described whereby glucocorticoids impair the synthesis of some proteins responsible for the stabilization of mRNA, leading to a faster degradation and a decrease in the expression of inflammatory proteins [35;37;38].
Taken together, glucocorticoids are potent and effective inhibitors of inflammation at different levels, modulating the inflammatory cascade, inhibiting the circulation of key inflammatory cells and the migration to the airways (Fig 1) [33;39]. In addition, glucocorticoids also stimulate the synthesis of beta-2-agonist receptors boosting the effect of bronchodilator medication [40].
Burden of severe glucocorticoid-dependent asthma
Epidemiological data on glucocorticoid-dependent asthma are difficult to obtain but estimations are that 1% of severe asthmatic patients are chronically treated with systemic glucocorticoids [27]. Recent analysis of a national prescription database (IQVIA Real-World Data Longitudinal Prescription database) showed that 2.6% of Dutch patients with asthma received systemic maintenance therapy with glucocorticoids, which in absolute numbers would represent approximately 16,000 patients in the Netherlands alone [41].
Despite the relatively small number of patients with severe glucocorticoid- dependent asthma compared with patients without maintenance treatment with systemic glucocorticoids, the complexity of the associated comorbidities and medication-driven side effects leads to important economic implications [15;27;42-46]. Studies have shown that health services related costs for patients with chronic use of systemic steroids might be 43 to 50% higher than for other patients with asthma [46].
It is also important to realise that health-related costs are proportional to the daily dose of corticosteroids consumed by the patient. Previous studies have demonstrated that incremental doses of OCS are associated with increased use of health care resources [47] and therefore have a significant impact on total annual costs [46;48]. This means that achieving the lowest effective dose of systemic glucocorticoids is not only important for the individual patient, but is also critical for public health care [49;50].
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