Findings suggest the rate of corticosteroid prescribing means alarge amount of patients may not have their asthma under control

The Asthma Society of Ireland has revealed data-based research commissioned to establish the level of oral corticosteroid (OCS) usage by people with asthma in Ireland, covering the period from November 2018 to October 2020. 

The research revealed that from the estimated 380,000 people with asthma in Ireland, almost 27 per cent (101,997) filled a prescription for OCS from a retail pharmacy in 2020, with 82,500 people with asthma collecting up to two OCS prescriptions over a 12-month period — an indication that they may not have their asthma under control, said the authors.

OCS can be associated with significant harmful side-effects as a result of long-term use. Research now indicates that even occasional short courses of OCS can be associated with increased health risks. 

The continual need to prescribe steroid tablets for a patient with mild-to-moderate asthma should signify that they need a review by their GP. The person with asthma may not be taking their controller inhaler every day, or they may not be using it properly.

The data also revealed that while the total number of people requiring steroid tablets for their asthma increased by 5,728 in 2019 from the previous year, the numbers decreased in 2020 by over 25,000 — a drop of 21 per cent. Reassuringly, the figures indicate OCS use among children fell by almost a third from 2018 to 2020, by 31 per cent compared to 10 per cent among adults during the same period. 

Concern

Of particular concern from the findings, 18.46 per cent of all people with asthma who are prescribed steroid tablets are using the medication three or more times per year, leaving them at significant risk of immediate side-effects, as well as cumulative health risks associated with OCS use into the future.

Commenting on the research, Ms Sarah O’Connor, CEO of the Asthma Society of Ireland, said: “While it is promising to see there was an overall decline of asthma patients needing steroid tablets over the past three years, especially among children, it is concerning that 82,511 people still filled up to two steroid prescriptions in 2020, indicating occasional loss of control of their asthma and the need to manage their condition.  

“I would like to encourage patients who have had two or more asthma attacks over the course of a year requiring OCS treatment to contact their GP and request an asthma review and updated personalised Asthma Action Plan. This recommendation has been made in the Global Initiative for Asthma guidelines for healthcare professionals.” 

Vulnerable group

Despite the overall drop in OCS usage, there has been an alarming increase in OCS use amongst a small but vulnerable group of people (4,212) whose numbers have increased between 2019 and 2020 by 26 per cent. These are patients who have collected OCS prescriptions three months or more in a row and are being prescribed consistent dosages over those months. The Asthma Society is particularly concerned about this group of patients. Independent of dose, prolonged use of steroid tablets has proven to be problematic for severe asthma patients, with experts claiming that they “could not find a well-founded threshold for side-effects of OCS or a dosing window for a ‘safe’ long-term use”.

Dr Marcus Butler, Respiratory Consultant at St Vincent’s University Hospital and Medical Director at the Asthma Society of Ireland, commented: “Due to the Covid-19 pandemic, people have been isolating at home, wearing masks and washing hands more frequently and we are therefore seeing a drop in steroid tablet use in 2020 among asthma patients, which is heartening.

Unfortunately, prolonged use of OCS medication has severe health implications. In the short term, side-effects can include sleep disturbance, mood changes, appetite increase and hyperglycaemia, while depression, diabetes, hypertension, and adrenal suppression are more of an issue in the longer term. It’s important to remember that OCS is the last tool we should reach for in our toolbox and a focus on improving better asthma control and management are preferred.”

Also responding to the research, Dr Dermot Nolan, GP, National Clinical Lead on Asthma to the HSE and Advisor to the Asthma Society, said: “If you are not taking your controller inhaler treatment every day, you may experience an asthma attack or flare-up that will require treatment with steroid tablets. 

“The best way for people with mild-to-moderate asthma to avoid needing steroid tablets is to take their controller inhaler medication every day — even when you feel well. We know from our research that almost 31,000 people bought asthma inhalers in 2020 that hadn’t in the previous two years, so we would like to encourage this trend to continue and ask that people have their reliever inhaler available for when their symptoms flare. 

“… A good rule of thumb is that if you have experienced two or more asthma attacks in one year requiring steroid treatment, then contact your GP and request an asthma review. Do not stop steroid therapy without talking to your doctor first, as doing so could be dangerous.” 

Ms O’Connor added: “The Asthma Society is calling on the Minister for Health, Stephen Donnelly, and the HSE to ensure that healthcare professionals are aware of and able to avail of the most impactful and effective treatments for their patients, including the use of high-tech medicines for severe asthma. The organisation is also urging that any cost-benefit assessments conducted by the NCPE on behalf of the State recognises the full extent of risk to patients of OCS use and makes its findings accordingly.” 

Furthermore, the Asthma Society called for urgent increased State funding to continue its work, which includes patient services, health promotion, awareness and advocacy initiatives that would allow it to fully utilise the findings of the research to the benefit of people with asthma.

This research was supported by AstraZeneca.