Expert consensus on the tapering of oral corticosteroids for the treatment of asthma: A delphi study

Carey M. Suehs, Andrew Menzies-Gow, David Price, Eugene R. Bleecker, Giorgio Walter Canonica, Mark Gurnell, Arnaud Bourdin

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Rationale: There is a need to minimize oral corticosteroid (OCS) use in patients with asthma to prevent their costly and burdensome adverse effects. Current guidelines do not provide recommendations for OCS tapering in patients with asthma. Objectives: To develop expert consensus on OCS tapering among international experts. Methods: A modified Delphi method was used to develop expert consensus statements relating to OCS use, tapering, adverse effects, adrenal insufficiency, and patient-physician shared decisionmaking. Initial statements proposed by experts were categorized, filtered for repetition, and presented back to experts over three ranking rounds to obtain consensus (>70% agreement). Measurements and Main Results: One hundred thirty-one international experts participated in the study, and 296 statements were ranked. Numerous recommendations and guidance regarding appropriate OCS use were established. Experts agreed that OCS tapering should be attempted in all patients with asthma receiving maintenance OCS therapy, with personalization of tapering rhythm and speed. The importance of recognizing individual adverse effects was also established; however, a unified approach to the assessment of adrenal insufficiency was not reached. Shared decisionmaking was considered an important goal during the tapering process. Conclusions: In this Delphi study, expert consensus statements were generated on OCS use, tapering, adverse-effect screening, and shared decision-making, which may be used to inform clinical practice. Areas of nonconsensus were identified, highlighting uncertainty among the experts around some aspects of OCS use in asthma, such as adrenal insufficiency, which underscores the need for further research in these domains.

Original languageEnglish (US)
Pages (from-to)871-881
Number of pages11
JournalAmerican journal of respiratory and critical care medicine
Issue number7
StatePublished - Apr 1 2021


  • Adrenal insufficiency
  • Adverse effects
  • Biological treatments
  • Shared decisionmaking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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