The Global Initiative of Asthma estimates that asthma affects 334 million people worldwide. Approximately 5% – or 17 million individuals – have severe, uncontrolled asthma despite attempts at treatment optimization. Oral glucocorticoids have been the mainstay of treatment. Recently, interest in the use of biologics to reduce steroid-toxicity has grown.
Given the robust literature on the multi-system adverse effects of steroids, the need for new therapies is urgent. However, the costs of biological therapies is high. Thus, the ability of these new prescriptions to reduce steroid-toxicity is of paramount importance.
Morbidity for glucocorticoid exposure in severe asthma is usually described at a population level. In general, steroid-related toxicity occurs in a dose-dependent manner, but this population based finding is of little use to the physician in the clinic or to individual patients.
Until the creation of the Steritas GTI, the management of severe asthma lacked a systematic approach to the measurement of treatment related adverse events.
An observational cohort study was performed using the GTI for systematic assessment of steroid-associated morbidity among prednisolone-dependent patients under routine clinical care. The cohort consisted of 101 patients, all of whom received high-dose inhaled glucocorticoid in combination with additional controller medications. Of these patients, 82% were also receiving daily maintenance prednisolone. The median cumulative prednisolone exposure for the preceding 12 months was 4280 mg. Commonly used measures of morbidity, including validated patient-reported outcome measures (PROMs) were used to quantify quality-of-life (QoL) and asthma control in order to determine the relationship of these factors to steroid-toxicity.
