Article (Scientific journals)
Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study.
Suehs, Carey M.; Menzies-Gow, Andrew; Price, David et al.
2021In American Journal of Respiratory and Critical Care Medicine, 203 (7), p. 871-881
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Keywords :
Administration, Oral; Adrenal Cortex Hormones/administration & dosage/standards/therapeutic use; Adult; Asthma/drug therapy; Consensus; Delphi Technique; Drug Administration Schedule; Expert Testimony; Female; Humans; Male; Middle Aged; Practice Guidelines as Topic; adrenal insufficiency; adverse effects; biological treatments; shared decision-making
Abstract :
[en] 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 decision-making. 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 decision-making 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.
Disciplines :
Immunology & infectious disease
Author, co-author :
Suehs, Carey M.
Menzies-Gow, Andrew
Price, David
Bleecker, Eugene R.
Canonica, Giorgio Walter
Gurnell, Mark
Bourdin, Arnaud
Other collaborator :
Cataldo, Didier  ;  Université de Liège - ULiège > Département des sciences cliniques > Labo de biologie des tumeurs et du développement
Language :
Title :
Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study.
Publication date :
Journal title :
American Journal of Respiratory and Critical Care Medicine
Publisher :
American Thoracic Society, United States - New York
Volume :
Issue :
Pages :
Peer reviewed :
Peer Reviewed verified by ORBi
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since 05 May 2021


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