Oral corticosteroid-dependent asthma: current knowledge and future needs.

Abstract:

PURPOSE OF REVIEW:To discuss the current use of oral corticosteroids (OCS) as a chronic treatment in patients with severe asthma and as a rescue treatment for patients presenting with acute exacerbations. RECENT FINDINGS:Airways disease is responsible for the bulk of OCS use in the community and considerable OCS-associated morbidity. I speculate that the key mechanism leading to a beneficial effect in these situations is depletion of circulating eosinophils resulting in a reduced response to potentially inhaled corticosteroid unresponsive recruitment signals to the airway mucosa. This effect is shared by anti-IL-5 biological agents, which have emerged as highly effective OCS-sparing agents. Mitigation of the adverse effects of OCS might also result from a better appreciation of features associated with a response to OCS and targeted, biomarker-directed use. SUMMARY:Longer term, there are real prospects that chronic and acute OCS use in asthma will be replaced by biological agents targeting eosinophilic airway inflammation more specifically and safely.

journal_name

Curr Opin Pulm Med

authors

Pavord ID

doi

10.1097/MCP.0000000000000541

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

51-58

issue

1

eissn

1070-5287

issn

1531-6971

journal_volume

25

pub_type

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