"For more than 20 years, we've had monoclonal antibodies for asthma, yet only one in five eligible patients are on them. And in more than 80 countries, there isn’t a single biologic available."

The overuse of systemic steroids remains a major yet underappreciated challenge in respiratory medicine. Despite their effectiveness in reducing inflammation, the long-term consequences, including diabetes, osteoporosis, and mood disturbances, continue to burden patients. Few people understand this landscape better than Tonya Winders, President and CEO of the Global Allergy and Airways Patient Platform (GAAPP). With over 25 years in respiratory and immunology, Winders has dedicated her career to patient advocacy, aiming to transform care pathways and reduce the reliance on steroids.

We sat down with Winders to discuss the evolving role of steroid stewardship, the barriers to accessing innovative treatments, and why systemic change is needed to ensure better patient outcomes.

"We Had to Listen to Understand"

Winders' advocacy for steroid stewardship stems from a deep awareness of its overlooked consequences.

"When I began to listen to people with lived experience, I was shocked. The level of sleep disturbance, mood swings, and relationship issues were just the short-term effects. Then, long-term complications like cataracts, osteoporosis, and diabetes were wreaking havoc on people's lives because they were repeatedly prescribed systemic steroids."

Her work at GAAPP has focused on addressing these gaps in patient education and clinical practice.

"We had to listen to understand. First, what were the harms? Second, why were patients reliant on steroids in the first place? And third, how do we help them recognize the trade-offs?"

For many patients, steroids remain the default treatment despite the availability of biologics and other alternatives.

"Yes, systemic steroids may provide a burst of energy and quick symptom relief. But is that worth the long-term harm?"

The Access Gap: "Half the World Has No Biologics Available"

One of the most striking disparities Winders highlights is the global access gap for innovative treatments.

"For more than 20 years, we've had monoclonal antibodies for asthma. Yet even in countries like the UK and the US, only one in five eligible patients are on them. And in more than 80 countries, there isn’t a single biologic available."

This gap exists due to several factors: economic constraints, lack of access to quality primary care, and structural barriers in healthcare systems.

"The reality is that patients in many parts of the world are still being managed with systemic steroids simply because the alternatives are inaccessible. The economics of healthcare often dictate treatment decisions, and unfortunately, biologics are still seen as costly compared to prednisone, despite the long-term burden of steroid-related complications."

Breaking the Perception That Steroids Are "Safe"

A major barrier to changing treatment paradigms is the perception that steroids are inherently safe while biologics carry greater risks.

"Eight years ago, when I started advocating for steroid stewardship, I was actually told by physicians never to use the term steroid-toxicity. They pushed back hard, saying it would scare patients. But the reality is, patients were already calling steroids their 'frenemy' - their friend because they kept them breathing, but their enemy because of the severe side effects."

Thanks to data collected in recent years, the financial and health consequences of steroid overuse are becoming more clear.

"Now we know that once a patient surpasses a certain threshold of systemic steroid exposure, their healthcare costs skyrocket - up to four times greater than the cost of a biologic long-term. But the challenge is getting payers and policymakers to look beyond short-term drug costs and consider the full economic burden of long-term steroid use."

Winders believes meaningful change will require a fundamental shift in both clinical practice and health policy.

"Healthcare systems are still largely designed around sick care, not preventative care. We need to stop managing diseases episodically and start prioritizing long-term patient health."

Beyond systemic change, she urges patients to take an active role in their own care.

"If you're living with asthma or COPD and still experiencing uncontrolled symptoms, don’t settle. Seek a specialist, push for advanced treatments, and educate yourself on all available options. There is hope, and no one should have to accept a life defined by their disease."

With advocates like Winders leading the charge, the push for steroid stewardship is gaining momentum. But as she reminds us, change happens when patients, clinicians, and policymakers work together.

"We have the knowledge and tools to do better. Now, we just have to act."

For those looking for more information, GAAPP provides a Steroid Stewardship Hub (available at https://gaapp.org/steroid-stewardship/) with resources to help patients understand the risks and explore alternative treatment strategies. As part of this effort, GAAPP has embraced Sam (www.steroidsandme.com) and is partnering with Steritas to help educate patients so they can better advocate for themselves.