A guideline for the use of systemic steroids in patients with severe asthma, reflecting the characteristics of domestic patients and the medical environment, has been presented.
The Korea Disease Control and Prevention Agency National Institute of Health released on the 14th the results of the "long-term follow-up study to identify causes of severe adult asthma in Korea and control exacerbations," conducted by Professor Kim Sang-heon's team at Hanyang University Hospital with institute support. According to the study, patients with severe asthma whose symptoms worsen frequently are difficult to treat, and not a few rely on systemic steroids for a long time.
The research team surveyed about 80 clinicians from the Korean Academy of Asthma, Allergy and Clinical Immunology on the actual use of systemic steroids and reviewed patterns of adverse reactions through analysis of related literature. The analysis found that when patients with severe asthma used 500 mg or more of prednisolone, a systemic steroid treatment, cumulatively over one year, the risk of side effects such as diabetes and cardiovascular disease increased significantly.
Even when systemic steroids were used for a relatively short period of 5 to 7 days due to acute exacerbations, the likelihood of side effects such as osteoporosis and hypertension increased if the cumulative dose exceeded 50 mg.
Based on these results, the research team established tapering criteria for systemic steroids applicable to patients with severe asthma in Korea. When taking 20 mg or more per day, reduce by 5 mg per week; when taking 10 to 20 mg, reduce by 2.5 mg per week. If taking less than 10 mg per day, it also proposed reducing by 2.5 mg over two weeks. When the dose reaches 5 mg per day, the risk of adrenal insufficiency should be assessed to adjust the tapering speed.
In addition, to reduce the side effects of systemic steroids, the research team said it is necessary to expand alternative treatments such as biologics that can maintain anti-inflammatory effects while addressing the limits of long-term use, and to provide health insurance coverage support.
The guideline was published as a position paper in a recent issue of the journal of the Korean Academy of Asthma, Allergy and Clinical Immunology.