How can we minimise the use of regular oral corticosteroids in asthma?

Arnaud Bourdin (1, 2) , Ian Adcock (3) , Patrick Berger (4) , Philippe Bonniaud (5) , Philippe Chanson (6) , Cecile Chenivesse (7, 8) , Jacques de Blic (9) , Antoine Deschildre (10) , Philippe Devilliers (11) , Gilles Devouassoux (12, 13) , Alain Didier (14) , Gilles Garcia (15) , Antoine Magnan (16) , Yan Martinat , Thierry Perez (17) , Nicolas Roche (18) , Camille Taillé (19) , Pierre Val (20) , Pascal Chanez (21)

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Imperial College London
4 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
5 Service des maladies respiratoires [CHU de Dijon]
6 PHYSENDO - Physiologie et physiopathologie endocriniennes
7 Service de Pneumologie, Immunologie et Allergologie [Lille]
8 Faculté de Médecine Henri Warembourg - Université de Lille
9 Hôpital Necker - Enfants Malades [AP-HP]
10 Service de pédiatrie
11 Hôpital Foch [Suresnes]
12 Hôpital de la Croix-Rousse [CHU - HCL]
13 UCBL - Université Claude Bernard Lyon 1
14 Service Pneumologie et allergologie pédiatrique [CHU Toulouse]
15 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
16 ITX - ITX - unité de recherche de l'institut du thorax
17 Hôpital Albert Calmette
18 Hôpital Cochin [AP-HP]
19 Service de Pneumologie A [Paris]
20 GReD - Génétique, Reproduction et Développement
21 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research

Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key "research statement proposals" were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn't be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year-1 should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.

Domaines: Pneumologie et système respiratoire; Allergologie; Pharmacologie

Arnaud Bourdin, Ian Adcock, Patrick Berger, Philippe Bonniaud, Philippe Chanson, et al.. How can we minimise the use of regular oral corticosteroids in asthma?. European Respiratory Review, 2020, 29 (155), pp.190085. ⟨10.1183/16000617.0085-2019⟩. ⟨hal-02470668⟩