Systematic literature review of systemic corticosteroid use for asthma management

Eugene R. Bleecker, Andrew N. Menzies-Gow, David B. Price, Arnaud Bourdin, Stephen Sweet, Amber L. Martin, Marianna Alacqua, Trung N. Tran

Research output: Contribution to journalReview articlepeer-review

189 Scopus citations


Systemic corticosteroid use to manage uncontrolled asthma and its associated healthcare burden may account for important healthrelated adverse effects. We conducted a systematic literature review to investigate the real-world extent and burden of systemic corticosteroid use in asthma. We searched MEDLINE and Embase databases to identify English-language articles published in 2010-2017, using search terms for asthma with keywords for oral corticosteroids and systemic corticosteroids. Observational studies, prescription database analyses, economic analyses, and surveys on oral/systemic corticosteroid use in children (>5 yr old), adolescents (12-17 yr old), and adults with asthma were included. We identified and reviewed 387 full-text articles, and our review included data from 139 studies. The included studies were conducted in Europe, North America, and Asia. Overall, oral/systemic corticosteroids were commonly used for asthma management and were more frequently used in patients with severe asthma than in those with milder disease. Long-term oral/systemic corticosteroid use was, in general, less frequent than short-term use. Compared with no use, long-term and repeated short-term oral/systemic corticosteroid use were associated with an increased risk of acute and chronic adverse events, even when doses were comparatively low. Greater oral/systemic corticosteroid exposure was also associated with increased costs and healthcare resource use. This review provides a comprehensive overview of oral/systemic corticosteroid use and associated adverse events for patients with all degrees of asthma severity and exposure duration. We report that oral/systemic corticosteroid use is prevalent in asthma management, and the risks of acute and chronic complications increase with the cumulative oral corticosteroid dosage.

Original languageEnglish (US)
Pages (from-to)276-293
Number of pages18
JournalAmerican journal of respiratory and critical care medicine
Issue number3
StatePublished - Feb 1 2020


  • Asthma
  • Oral corticosteroids
  • Severe asthma
  • Systematic literature review
  • Systemic corticosteroids

ASJC Scopus subject areas

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


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