Overuse Of Oral Corticosteroids, Underuse Of Inhaled Corticosteroids, And Implications For Biologic Therapy In Asthma

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) often require high doses of oral corticosteroids (OCSs) for exacerbation management, which can lead to significant adverse effects. Biologic therapies are being explored as alternatives to OCSs in severe COPD, but the appropriateness of prescribing these costly treatments needs evaluation.

Objectives: This study aimed to (1) determine the prevalence of COPD patients using high cumulative doses of OCSs, (2) investigate the impact of suboptimal inhaler technique on OCS use, and (3) estimate the proportion of patients for whom biologic therapies may be unnecessarily prescribed.

Methods: We identified adults with COPD (n = 5,002) using high-dose inhaled corticosteroids (≥500–1,000 mcg/day fluticasone-equivalent) and/or OCSs (Global Initiative for Chronic Obstructive Lung Disease [GOLD] group D) from a pharmacy database coverin[1]g 500,500 individuals. Questionnaires were sent to 2,312 patients who returned them, of which 929 were diagnosed with COPD. We calculated annual cumulative OCS doses and assessed inhaler technique in a subgroup of 60 patients. Patients with good adherence and inhaler proficiency but still requiring high OCS doses (≥420 mg/year) were considered potential candidates for biologic therapy.

Results: Among COPD patients in GOLD group D, 29.5% were using high doses of OCSs, with 78.1% likely having suboptimal therapy adherence or inhaler technique. Only 21.9% were deemed suitable candidates for biologic treatment.

Conclusion: High OCS use is prevalent among COPD patients in GOLD group D, but a significant proportion exhibit poor therapy adherence or inhaler technique. Optimizing inhaler therapy should be prioritized before considering expensive biologic therapies as alternatives to OCSs in severe COPD management.