D2.82 - Association between additional corticosteroid usage and Uncontrolled Severe Asthma: A Retrospective Study Using the China Regional Database

As resorts, additional corticosteroids (e.g. oral corticosteroids, OCS) may be considered for some adults with severe asthma, and often associated with substantial cumulative side effects. However, the utilization of additional corticosteroids and the relationship between their usage and control status in severe asthma patients in China have not been clarified.

Patients aged ≥ 12 years with severe asthma, defined by ICD-10 codes and having at least two prescriptions for medium-to-high dose inhaled corticosteroids (ICS) within the prior six months, were identified from the Shanghai Medical Database between January 1, 2016, and December 31, 2020. The index date was the day after the most recent ICS prescription meeting severe asthma criteria. Additional corticosteroids (oral, intravenous, or nebulized) utilization and asthma control status of patients were assessed using data from one year before and after the index date, respectively. A multivariable logistic regression model was employed to explore the relationship between them.

 A total of 35900 severe asthma patients (mean age 57±16.2 years; 50.9% female) were included. Among them, 29.0% had diabetes, 27.2% had stroke, 20.6% had cataracts, and 13.1% had peptic ulcer. The proportion of patients using OCS was 7.7% (5.3% with one prescription; 2.4% with ≥ 2 prescriptions), with an annual mean cumulative dose of 438.8 (±663.1) mg and a duration of 21.9 (±34.7) days. Among these, 78.2% received OCS for <30 days, 16.9% for 30 to <90 days, 3.9% for 90 to <180 days, and 1.0% for ≥180 days. Additionally, 4456 (12.4%) received intravenous corticosteroids, and 1,657 (4.6%) received nebulized ICS. Patients with two or more OCS prescriptions (OR=1.95, 95%CI: 1.65-2.30, p<0.001), intravenous corticosteroids (OR=1.96, 95%CI: 1.77-2.16, p<0.001), or nebulized ICS (OR=1.18, 95%CI: 1.04-1.33, p=0.008), were significantly more likely to experience uncontrolled asthma during follow-up, after adjusting for age, sex, T2-related comorbidities, baseline asthma control, and use of controllers and short-acting β-agonist (SABA).

Oral, intravenous, and nebulized corticosteroids remain widely used in the treatment of severe asthma and are associated with long-term uncontrolled status. Patients with relevant comorbidities may face additional risks from additional corticosteroids use. Thus, alternative therapeutic strategies should be explored to optimize the management of severe asthma, ensuring both long-term efficacy and safety.