Principles of management of severe asthma patients treated with systemic glucocorticosteroids – Experts’ recommendations on dose reduction and discontinuation of these drugs

According to GINA guidelines chronic therapy with oral glucocorticosteroids in patients with severe asthma must be limited to those who have been excluded from biological therapies, and other interventions have proved unsuccessful, as the use of even single doses of systemic glucocorticosteroids is associated with the risk of severe side effects. Therefore, optimal asthma control should be pursued in all cases, and each patient must be monitored for the number of exacerbations and the use of systemic corticosteroids. This will allow the identification of patients who are not optimally treated, who should be referred to specialist centers in order to deepen the differential diagnosis and possibly initiate biological therapy. In most patients, this enables a reduction in the number of exacerbations, as well as a significant dose reduction or withdrawal of long-term oral glucocorticosteroids, the use of which should be significantly limited due to numerous side effects. Discontinuation of oral glucocorticosteroids is a major problem, as symptoms of adrenal insufficiency develop in more than half of patients after prolonged use of these drugs. These are the first recommendations regarding the proposed diagnostic and therapeutic management in this group of patients.