In this episode, we focus on the burden of over-reliance on steroids used in the treatment of asthma with Dr Hitasha Rupani, who reflects on her experiences as a Respiratory Consultant based at Southampton Hospitals NHS Trust.
Dr Hitasha Rupani would like her take-home messages to be:
- We can do better at the earlier recognition of poorly controlled asthma. This means identifying patients early on in their patient journey, optimising their treatment and referring them to severe asthma centres if required.
- Realise the importance of empowering patients and providing them with the tools to self-manage their asthma better, by giving them educational information about their condition in a way they want to receive it.
- Be mindful of the negative impact that over-reliance of oral corticosteroids can have on the patient. They have a place in the acute setting but should not be used long term.
Useful links
References
- Price DB, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193-204.
- Price D, et al. Asthma referrals: a key component of asthma management that needs to be addressed. J Asthma Allergy. 2017;10:209-223.
- Volmer T, et al. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature. Respir J. 2018;52:1800703.
- Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2020. Available from: https://ginasthma.org/reports/ (last accessed May 2021)
- Asthma UK. Asthma facts and statistics. Available from: https://www.asthma.org.uk/about/media/facts-and-statistics/ (last accessed May 2021)
- Asthma UK. Living in limbo. 2019. Available from: https://www.asthma.org.uk/support-us/campaigns/publications/living-in-limbo/ (last accessed May 2021)
- Asthma UK. The reality of asthma care in the UK: annual asthma survey 2018 report. 2019. Available from: https://www.asthma.org.uk/globalassets/get-involved/external-affairs-campaigns/publications/annual-asthma-care-survey/annual-asthma-survey-2018/asthmauk-annual-asthma-survey-2018-v7.pdf (last accessed May 2021)
- Asthma UK. The great asthma divide. 2019. Available from: https://www.asthma.org.uk/58a0ecb9/globalassets/campaigns/publications/The-Great-Asthma-Divide.pdf (last accessed May 2021)
- Asthma UK. On the edge. 2018. Available from: https://www.asthma.org.uk/dd78d558/globalassets/get-involved/external-affairs-campaigns/publications/health-inequality/auk-health-inequalities-final.pdf (last accessed May 2021)
- Royal College of Physicians. Why asthma still kills. The National Review of Asthma Deaths (NRAD). 2014. Available from: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills (last accessed May 2021)
- Black RJ, et al. Factors associated with oral glucocorticoid use in patients with rheumatoid arthritis: a drug use study from a prospective national biologics registry. Arthritis Res Ther. 2017;19:253.
- Chhaya V, et al. Steroid dependency and trends in prescribing for inflammatory bowel disease – a 20-year national population-based study. Aliment Pharmacol Ther. 2016;44:482-494.
- British Thoracic Society, Scottish Intercollegiate Guidelines Network. SIGN158 British guideline on the management of asthma. 2019. Available from: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ (last accessed May 2021)
- Chung KF, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43:343-373.
- Wiffen L, et al. The impact of maintenance oral corticosteroids (mOCS) on disease burden and type-2 inflammatory signal in the Wessex Severe Asthma Cohort (WSAC). ERS Congress. 2020; e-poster 2678.
- Asthma UK. Slipping through the net. 2018. Available at: https://www.asthma.org.uk/globalassets/get-involved/external-affairs-campaigns/publications/severe-asthma-report/auk-severe-asthma-gh-final.pdf (last accessed May 2021)
- Ryan D, et al. Potential severe asthma hidden in UK primary care. J Allergy Clin Immunol Pract. 2020;S2213-2198(20)31327-1.
- Voorham J, et al. S29 Longitudinal systemic corticosteroid utilisation for asthma and other diseases in the United Kingdom from 1990 to 2018: a population-based cohort analysis. Thorax. 2021;76(Suppl 1):A21-A21.