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Asthma Patients’ Corticosteroid Conundrum

For someone with a flare-up of asthma symptoms, a short course of oral corticosteroids like prednisone can be a welcome relief.  But when these potent medications become a regular remedy, asthma patients may have a problem.

Oral corticosteroids are prescription pills taken to reduce inflammation in the airways and lungs.  They are different from inhaled corticosteroids, which patients use regularly to control wheezing and coughing.  A three-to-five day “burst” of oral corticosteroids can, for example, rescue patients from a stubborn asthma flare that might otherwise lead to hospitalization. 

But overuse of these medications can cause side effects: weight gain, bone thinning, cataracts, mood swings, insomnia and growth problems for children.  And, notably, asthma may not be the only condition for which a patient is prescribed oral corticosteroids.  For instance, an asthma patient prescribed prednisone by her allergist also could be prescribed the medication by her dermatologist for skin issues or by her primary care doctor for another condition.  More frequent use invites higher risk.     

Meanwhile, repeated use of oral corticosteroids for asthma relief can indicate a deeper problem.

“If a patient of mine needs two or more bursts of prednisone a year, that’s an alarm bell,” explained allergist and immunologist Allen Meadows, MD, of the Alliance for Patient Access’ Respiratory Therapy Access Working Group. “Then it’s time for us to revisit that patient’s treatment plan and find a more effective way to manage his or her asthma.” 

Some patients, including those with severe asthma, may need injected or infused biologic medicines  to control their condition.  In fact, over-reliance on oral corticosteroids might indicate that a patient might benefit from a more targeted therapy like a biologic.  Appropriate access and health plan coverage for these medications is important for moderate-to-severe patients to properly manage their asthma. 

And better-controlled asthma offers a host of benefits for adult and child patients alike – fewer missed days of work or school, fewer trips to the emergency room for acute exacerbations, more restful sleep and better quality of life.  Equally important, controlling one’s asthma can reduce the need for high-potency but potentially risky medications like oral corticosteroids.