Severe asthma management faces new challenges as oral corticosteroid (OCS) usage distorts key biomarkers, potentially misguiding treatment decisions. A recent international study sheds light on how both intermittent and long-term OCS prescriptions impact asthma phenotypes and biomarker distributions in real-world settings.
Impact of OCS on Biomarker Distribution
Analyzing data from over 4,300 patients across 23 countries between 2003 and 2023, researchers categorized severe asthma sufferers based on their OCS usage: none, intermittent, or long-term. The study focused on blood eosinophil counts (BEC), fractional exhaled nitric oxide (FeNO), and total Immunoglobulin E (IgE) levels. Findings revealed that long-term OCS users exhibited significantly lower BEC compared to those on intermittent or no OCS, raising concerns about accurate phenotype classification.
Clinical Burden in Long-Term OCS Users
Patients on long-term OCS demonstrated a high disease burden regardless of their BEC levels or OCS dosage. Approximately 40% experienced multiple exacerbations, over 75% struggled with uncontrolled asthma symptoms, and more than half showed persistent airflow obstruction. These statistics underscore the relentless nature of severe asthma in long-term OCS patients, highlighting the need for alternative therapeutic strategies.
Key Insights:
- OCS usage alters BEC, complicating phenotype identification.
- Long-term OCS users face significant asthma control challenges.
- FeNO remains a reliable biomarker unaffected by OCS suppression.
- Early phenotyping could enhance treatment efficacy for severe asthma patients.
The study emphasizes that OCS, whether used intermittently or continuously, can skew biomarker profiles, particularly BEC, leading to potential misclassification of asthma phenotypes. This distortion affects subsequent treatment plans, possibly limiting the effectiveness of biologic therapies tailored to specific asthma types. Interestingly, FeNO levels remained largely unaffected by OCS, suggesting it as a more stable biomarker in patients undergoing steroid treatment.
Addressing the high disease burden in long-term OCS users is crucial. The persistent symptoms and frequent exacerbations observed in these patients indicate that current treatment protocols may be insufficient. Alternative treatments and earlier, more accurate phenotyping could provide better management options, reducing reliance on OCS and improving quality of life for those with severe asthma.
Effective management of severe asthma requires a nuanced understanding of how treatments like OCS influence disease biomarkers and patient outcomes. By recognizing the masking effects of OCS on BEC and leveraging more resilient indicators like FeNO, healthcare providers can refine their diagnostic and treatment approaches. This proactive strategy not only enhances the precision of asthma phenotyping but also paves the way for more personalized and effective therapeutic interventions, ultimately improving patient care and reducing the long-term burden of severe asthma.
This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.
