Why Doctors And Patients In Italy Still Rely On Oral Corticosteroids For Asthma

Surveys of much than 1,000 Italian patients and clinicians uncover why oral steroid usage remains wide successful asthma care, revealing gaps successful line adherence, diligent education, and entree to precocious biologic therapies.

Study: Use of oral corticosteroids successful patients pinch asthma: really acold is objective believe from nan guidelines? Results from surveys of patients and doctors. Image credit: zlikovec/Shutterstock.com

A caller Frontiers successful Allergy study examined usage patterns and barriers to adherence to oral corticosteroid (OCS) curen guidelines for asthma successful Italy. To do so, surveys were conducted pinch healthcare professionals (HCPs) and patients.

The guidance of asthma utilizing oral corticosteroids

Asthma affects an estimated 262 cardinal group worldwide, pinch nan highest incidence seen successful children nether nine. Globally, its prevalence has accrued by astir 15% betwixt 1990 and 2019. In Italy alone, astir 4 cardinal group unrecorded pinch asthma, including astir 200,000 pinch terrible asthma (SA), a group that represents a important load connected healthcare resources and costs.

The guidance of SA often requires nan usage of long-acting β2-agonists (LABAs), inhaled corticosteroids (ICS), and long-acting muscarinic antagonists (LAMAs). Existing guidelines urge nan usage of OCS only arsenic a past action owed to terrible adverse effects, specified arsenic maturation impairment successful children and iatrogenic adrenal insufficiency. Despite this, OCS medications are commonly prescribed successful asthma treatment. However, patients person their concerns, and investigation shows that astir 44% of adults study worries astir OCS use, sometimes starring them to trim aliases discontinue curen without aesculapian supervision by HCPs. Therefore, a spread exists betwixt objective believe and guidelines, which needs to beryllium examined.

About nan study

To reside nan knowledge spread betwixt guidelines and objective believe concerning asthma treatment, nan Respiriamo Insieme Association successful Italy, successful collaboration pinch Sanofi, conducted 2 surveys among HCPs (survey 1) and patients (survey 2). The existent study documents nan results of these surveys, which purpose to trim OCS dependence and heighten nan value of life of SA patients.

Survey 1 comprised 7 closed-ended questions (six multiple-choice and 1 standing scale) and gathered insights into nan OCS prescribing practices, barriers to due use, imaginable overuse patterns, and adherence to existent guidelines. Survey 2 explored patients’ perspectives connected consciousness and engagement successful curen decisions, usage patterns, curen accommodation and monitoring, acquisition provided by HCPs, guidance of adverse events (AEs), and information practices concerning OCS use.

Study findings

A full of 366 HCPs completed nan survey, and 82% preferred a 10-day OCS curen duration. A long of much than 21 days was preferred by 14% of HCPs, and nan remaining opted for longer curen durations. Ninety-nine percent of HCPs said that either much than 6 months of OCS usage per twelvemonth aliases 2 aliases 3 cycles per twelvemonth was basal to categorize a diligent arsenic OCS-dependent. The remaining 1% thought a azygous rhythm was enough. Concerning nan yearly cumulative corticosteroid use, 28% reported ne'er keeping way of nan full OCS dose for their patients, 40% reported doing this, 24% did this occasionally, and nan remaining 8% based their calculations connected prescribed OCS doses.

Twenty-seven percent of HCPs thought nan maximum safe regular dose was 7.5 mg/day, while 43% put this astatine 5 mg/day. Twelve and 18% thought nan safe limits were 2 mg/day and 10 mg/day, respectively. Regarding strategies to minimize nan OCS dose successful managing SA, 43% responded that changing nan ICS/LABA operation was nan astir effective. This was intimately followed by utilizing biologic therapies (37%). More than half of nan HCPs thought that a multidisciplinary attack is important to forestall adverse effects of OCS, and astir 44% recommended monitoring visits for bony densitometry each 2 years.

Overall, patients and their families/caregivers completed 829 questionnaires, of which 468 belonged to patients pinch SA. Only two-thirds of patients pinch non-SA were prescribed OCS, compared pinch 95% of patients pinch SA. Around 47% of SA patients utilized OCS much than once, for astatine slightest 2 cycles per year, compared pinch 27% of non-SA patients. Overall, 13% of SA and 14% of non-SA patients reported having ceased OCS use. Forty-seven percent of SA patients and 24% of non-SA patients utilized OCS erstwhile a twelvemonth aliases much without a valid prescription. Forty percent of SA and 31% of non-SA patients did not taper nan dose erstwhile stopping, while 52% and 33% of SA and non-SA patients did, respectively.

In astir 71% of SA patients, nan expert progressive them successful nan determination to return OCS, compared to 43% for non-SA patients. Physicians did not pass 45% of non-SA and 49% of SA patients astir nan imaginable alternatives to OCS, respectively. Concerning nan semipermanent strategy, inhaler medications were communal successful nan non-SA group, while biologics were astir communal successful nan SA group.

Twenty-two percent of non-SA patients reported being informed astir adverse reactions, whereas 35% reported ne'er being informed. Among nan SA patients, 41% were informed astir imaginable broadside effects, while 57% reported not being referred to a specialist. Most patients did not person a bony wellness assessment. The study besides recovered that astir 40% of patients self-administered OCS astatine slightest erstwhile per twelvemonth without a prescription, often owed to fearfulness of exacerbations aliases trouble accessing healthcare. This reflects nan easiness of entree to OCS without a medicine successful Italy. A overmuch higher proportionality of SA patients acquired OCS without a valid prescription, comparative to non-SA patients.

Conclusions

The findings show a important discrepancy betwixt line recommendations and objective practice, and OCS usage remains very precocious successful Italy. Reducing unnecessary OCS usage done biologic therapies could besides thief little healthcare costs.

Several unmet needs and projected systemic reforms: establishing a clearer and pragmatic meaning of “OCS dependency,” improving diligent acquisition and shared decision-making, expanding entree to multidisciplinary attraction (including psychological support), and utilizing integer aliases diary-based monitoring devices to way OCS adherence and broadside effects.

A cardinal limitation of nan study was nan inability to separate betwixt respondents from pediatric and big attraction settings. This whitethorn person led to misinterpretation of notable differences successful OCS usage betwixt adults and children. Secondly, nan study's cross-sectional quality exposes it to consequence bias, inaccurate self-reporting, and callback bias. Finally, nan results whitethorn not beryllium generalizable to different populations arsenic nan study was conducted connected a selected group of Italian HCPs and patients.

The study underscores nan persistence of precocious OCS usage contempt line recommendations, highlighting nan request for coordinated education, standardized monitoring, and integrated psychological and master attraction to trim unnecessary OCS vulnerability successful terrible asthma management.