Home » Respiratory » Severe asthma: the impact of inappropriate OCS use

Dr Nadia Malik

PhD, Medical Affairs Manager, GSK UK

Severe asthma experts are advocating for a change in OCS treatment norms for patients with more severe forms of the condition.

Oral corticosteroids (OCS) are anti-inflammatory medicines used to treat a range of conditions including asthma. Most people with asthma manage their symptoms with inhalers. Severe asthma is a condition that is inadequately controlled by inhalers, so regular courses of OCS tablets are often used to treat a severe asthma attack.   

Dr Andrew Whittamore, GP with a respiratory interest, explains:

Oral corticosteroids are cheap and very effective for people struggling with their asthma; they can be lifesaving. However, it is clear that patients, healthcare professionals and the wider NHS must not be complacent about the regular use of oral corticosteroids and need to do more to safeguard patients against their side effects.

Dr Andrew Whittamore, GP

Consequences of OCS treatment for asthma 

Increasingly, specialists are questioning the wide use of OCS in patients with severe asthma. A report called ‘Do No Harm’ by Asthma and Lung UK, a charity fighting to transform lung health, states: “These tablets can stop the symptoms, but they have devastating side effects in the short and long term on physical and mental health — from suicidal thoughts and insomnia to diabetes and kidney damage.”  

An additional study suggests that people on regular OCS treatment are three times more likely to suffer from osteoporosis/osteoporotic fractures; more than twice as likely to suffer from pneumonia; and have a 1.34-fold greater risk of death. 

5–10% of the UK asthma population is estimated to have severe asthma — equivalent to approximately 200,000 children and adults. However, the cost of treating these patients is four times higher than general asthma patients, driven by the cost of treating the side effects of OCS.

Listening to the patient experience 

Patients say that the cumulative negative outcomes of long-term OCS use are rarely discussed, and healthcare professionals often prescribe a course of OCS to manage an acute asthma attack without an objective, in-person review.

Val, a patient who shared their firsthand experience at a recent GSK summit on OCS use, says: “No GP or hospital physician ever informed me I would get debilitating side effects from OCS use. I was hesitant to ask questions of my healthcare professionals and eventually found out myself from other people in the community, my work with Asthma and Lung UK and self-education from podcasts. I wish I had known.” 

How can we improve treatment for patients? 

There needs to be a two-pronged approach. Firstly, identification and referral to specialist centres need to improve. Dr Katherine Hickman, GP and Executive Chair of the Primary Care Respiratory Society, believes that patients who have had an acute asthma attack which resulted in OCS being prescribed should routinely be followed up with a GP review to assess the cause of the asthma attack and if any further management is needed.  

Current guidelines indicate that patients with suspected severe asthma, or those requiring two or more courses of OCS within 12 months, should be referred to a specialist centre for assessment — but experts acknowledge this rarely happens.  

Secondly, specialists agree that better education among healthcare professionals about the side effects of inappropriate OCS use is needed. This can be coupled with patient education about the side effects of OCS to empower patients to self-advocate. 

Focusing on alternative treatments for severe asthma 

Prof Liam Heaney, Professor of Respiratory Medicine, concludes:

For years, OCS were the mainstay of treatment for patients with severe asthma, but we have recognised for many years that these cause multiple, serious side effects. The challenge now is to identify patients who would benefit from much earlier intervention with appropriate treatments — such as biologics — to ensure optimal outcomes for this group.

Prof Liam Heaney, Professor of Respiratory Medicine

NP-GB-ASU-OGM-230002 I June 2023

Next article