Page 41 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 41
ccording to the cortisol assay used and local and prevention [Internet]. Fontana, 41
practices. For example, basal morning corti- WI: Global Initiative for Asthma; 2021
sol that excluded AI varied between 336 and [cited 2021 Sep 30]. Available from: challenges of systemic glucocorticoids taper in the treatment of severe asthma
506 nmol/L when measured by three differ- https://ginasthma.org.
ent immunoassays. Therefore, the cut-offs 3. Chung KF, Wenzel SE, Brozek JL, et
proposed here should be seen as a direction al. International ERS/ATS guidelines
only. Additionally, patients should be test- on definition, evaluation and treatment
ed at least 24 h after the last dose of exoge- of severe asthma. Eur Respir J. 2014
nous GC, because (methyl) prednisolone can Feb;43(2):343-73.
interfere with immunoassays and cause false- 4. Alangari AA. Corticosteroids in the
ly elevated cortisol values. To completely ex- treatment of acute asthma. Ann Thorac
clude this possibility, patients could be also Med. 2014 Oct;9(4):187-92.
switched to a replacement dose of hydrocorti- 5. Price DB, Trudo F, Voorham J, et al.
sone, a short-acting GC, before testing serum Adverse outcomes from initiation of sys-
cortisol23. temic corticosteroids for asthma: long-
term observational study. J Asthma Al-
In the case of AI, the switch to hydrocor- lergy. 2018 Aug 29;11:193-204.
tisone replacement therapy was generally pre- 6. Bengtson LGS, Yu Y, Wang W, et al.
ferred by the experts to continued predniso- Inhaled corticosteroid-containing treat-
lone, but the consensus was not reached25,21. ment escalation and outcomes for pa-
Theoretically, its shorter half-life might ac- tients with asthma in a U.S. health
celerate the recovery of HPA axis by negative care organization. J Manag Care Spec
feedback, especially when avoiding late after- Pharm. 2017 Nov;23(11):1149-59.
noon exposure to hydrocortisone23. Switch 7. Price D, Castro M, Bourdin A, et
to hydrocortisone is also recommended from al. Short-course systemic corticos-
practical reasons, for instance when low- teroids in asthma: striking the bal-
strength GC tablets, such as (methyl) predni- ance between efficacy and safety. Eur
solone 1 mg tablet, are not available. Respir Rev. 2020;29(155):190151. doi:
10.1183/16000617.0151-2019.
Conclusions 8. Younes AK, Younes NK. Recovery of
steroid induced adrenal insufficiency.
Modern anti-inflammatory treatment with Transl Pediatr. 2017 Oct;6(4):269-73.
biologics is changing lives of many patients 9. Poetker DM, Reh DD. A comprehensive
with severe asthma who had to rely on sys- review of the adverse effects of systemic
temic GC and cope with their potentially se- corticosteroids. Otolaryngol Clin North
rious side effects in the past. However, clini- Am. 2010 Aug;43(4):753-68.
cians should be aware that life-threatening 10. Djukanovic R, Adcock IM, Ander-
AI is common among systemic GC users and son G, et al. The Severe Heterogene-
should familiarize themselves with correct ous Asthma Research collaboration,
GC tapering and cessation. Patient-centred (SHARP) ERS Clin-
ical Research Collaboration: a new
References dawn in asthma research. Eur Respir
J. 2018 Nov 29;52(5):1801671. doi:
1. Holgate ST, Wenzel S, Postma DS, 10.1183/13993003.01671-2018.
et al. Asthma. Nat Rev Dis Primers. 11. van Bragt JJMH, Adcock IM, Bel
2015 Sep 10;1(1):15025. doi: 10.1038/ EHD, et al. Characteristics and treat-
nrdp.2015.25. ment regimens across ERS SHARP
2. Global Initiative for Asthma. Glob-
al strategy for asthma management
practices. For example, basal morning corti- WI: Global Initiative for Asthma; 2021
sol that excluded AI varied between 336 and [cited 2021 Sep 30]. Available from: challenges of systemic glucocorticoids taper in the treatment of severe asthma
506 nmol/L when measured by three differ- https://ginasthma.org.
ent immunoassays. Therefore, the cut-offs 3. Chung KF, Wenzel SE, Brozek JL, et
proposed here should be seen as a direction al. International ERS/ATS guidelines
only. Additionally, patients should be test- on definition, evaluation and treatment
ed at least 24 h after the last dose of exoge- of severe asthma. Eur Respir J. 2014
nous GC, because (methyl) prednisolone can Feb;43(2):343-73.
interfere with immunoassays and cause false- 4. Alangari AA. Corticosteroids in the
ly elevated cortisol values. To completely ex- treatment of acute asthma. Ann Thorac
clude this possibility, patients could be also Med. 2014 Oct;9(4):187-92.
switched to a replacement dose of hydrocorti- 5. Price DB, Trudo F, Voorham J, et al.
sone, a short-acting GC, before testing serum Adverse outcomes from initiation of sys-
cortisol23. temic corticosteroids for asthma: long-
term observational study. J Asthma Al-
In the case of AI, the switch to hydrocor- lergy. 2018 Aug 29;11:193-204.
tisone replacement therapy was generally pre- 6. Bengtson LGS, Yu Y, Wang W, et al.
ferred by the experts to continued predniso- Inhaled corticosteroid-containing treat-
lone, but the consensus was not reached25,21. ment escalation and outcomes for pa-
Theoretically, its shorter half-life might ac- tients with asthma in a U.S. health
celerate the recovery of HPA axis by negative care organization. J Manag Care Spec
feedback, especially when avoiding late after- Pharm. 2017 Nov;23(11):1149-59.
noon exposure to hydrocortisone23. Switch 7. Price D, Castro M, Bourdin A, et
to hydrocortisone is also recommended from al. Short-course systemic corticos-
practical reasons, for instance when low- teroids in asthma: striking the bal-
strength GC tablets, such as (methyl) predni- ance between efficacy and safety. Eur
solone 1 mg tablet, are not available. Respir Rev. 2020;29(155):190151. doi:
10.1183/16000617.0151-2019.
Conclusions 8. Younes AK, Younes NK. Recovery of
steroid induced adrenal insufficiency.
Modern anti-inflammatory treatment with Transl Pediatr. 2017 Oct;6(4):269-73.
biologics is changing lives of many patients 9. Poetker DM, Reh DD. A comprehensive
with severe asthma who had to rely on sys- review of the adverse effects of systemic
temic GC and cope with their potentially se- corticosteroids. Otolaryngol Clin North
rious side effects in the past. However, clini- Am. 2010 Aug;43(4):753-68.
cians should be aware that life-threatening 10. Djukanovic R, Adcock IM, Ander-
AI is common among systemic GC users and son G, et al. The Severe Heterogene-
should familiarize themselves with correct ous Asthma Research collaboration,
GC tapering and cessation. Patient-centred (SHARP) ERS Clin-
ical Research Collaboration: a new
References dawn in asthma research. Eur Respir
J. 2018 Nov 29;52(5):1801671. doi:
1. Holgate ST, Wenzel S, Postma DS, 10.1183/13993003.01671-2018.
et al. Asthma. Nat Rev Dis Primers. 11. van Bragt JJMH, Adcock IM, Bel
2015 Sep 10;1(1):15025. doi: 10.1038/ EHD, et al. Characteristics and treat-
nrdp.2015.25. ment regimens across ERS SHARP
2. Global Initiative for Asthma. Glob-
al strategy for asthma management
