Third of patients with severe asthma taking harmful doses of oral steroids

Nearly one third of patients with severe asthma are taking harmful doses of oral steroids, according to a study of more than 500,000 Dutch patients presented at the European Respiratory Society International Congress.

Analysis of a pharmacy database revealed that 29% of asthma patients who were using high doses of inhaled steroids (500 micrograms or more a day) were also taking harmfully high doses of oral steroids of 420 milligrams a year or more. 

Of these patients, 78% had poor adherence to inhaled medication or incorrect inhalation technique.

“These problems should be tackled first in these patients before considering biologic treatment. The remaining 22% are candidates for biologic drugs,” said lead researcher Dr Katrien Eger, trainee respiratory physician at Amsterdam University Medical Centre.

She added that her research did not show why so many patients were overusing oral steroids and so few were receiving biologic treatments, but the reasons could be that patients don't consult their doctors and that, when they do, the doctors don't assess them thoroughly or don't identify them as being candidates for biologic treatment.

Steve Holmes, PCRS Education Lead, commented: “This poster appears to demonstrate that those people on higher dose inhaled corticosteroids are those more likely to need two or more courses of steroids during the year. It also highlights issues of inhaler technique and adherence to medication regime that will be familiar to many of us. It is important to consider carefully when the element of control is poor and warrants referral and we hope that the PCRS guide on poorly controlled and severe asthma will help to trigger clinicians to think and refer appropriately.”

Other ERS research highlights include:

• A survey of 905 Italian truck drivers has shown that approximately half suffer from at least one sleep-related breathing problem that potentially can cause drivers to fall asleep at the wheel.
• A smart shirt that measures lung function by sensing movements in the chest and abdomen can accurately measure breathing and could be used to monitor COPD and other lung diseases.
• Air pollution is linked to increased risk of infant deaths and reduced lung function in children, according to a study of nearly eight million live births in England and Wales. 
• In another presentation on air pollution, Anna Hansell, Professor in Environmental Epidemiology, University of Leicester, reported that data from the UK Avon Longitudinal Study of Parents and Children revealed that exposure to air pollution from road traffic in the first trimester of pregnancy and in early life is associated with small but significant reductions in children's lung function at the age of eight years. "It's really important to prioritise reduction of air pollution levels to improve respiratory health. In separate work, we have also shown associations with lower lung function in adulthood, suggesting that air pollution contributes to ageing of the lungs,” she said.