Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study.

Tytuł:: Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study.
Autorzy:: Suehs CM; Département des Maladies Respiratoires and.
Menzies-Gow A; PhyMedExp, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Centre Hospitalier Universitaire Montpellier, Montpellier, France.
Price D; Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom.; Observational and Pragmatic Research Institute, Singapore.
Bleecker ER; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
Canonica GW; Department of Medicine, University of Arizona, Tucson, Arizona.
Gurnell M; Personalized Medicine, Asthma and Allergy Center, Humanitas University and IRCCS Research Hospital, Milan, Italy; and.; Wellcome Trust-Medical Research Council Institute of Metabolic Science and.
Bourdin A; Département des Maladies Respiratoires and.; Cambridge National Institute for Health Research Biomedical Research Centre, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom.
Corporate Authors:: Oral Corticosteroids Tapering Delphi Expert Panel
Źródło:: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2021 Apr 01; Vol. 203 (7), pp. 871-881.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 2000- : New York, NY : American Thoracic Society
Original Publication: New York, NY : American Lung Association, c1994-
MeSH Terms:: Drug Administration Schedule*
Expert Testimony*
Adrenal Cortex Hormones/*administration & dosage
Adrenal Cortex Hormones/*standards
Adrenal Cortex Hormones/*therapeutic use
Asthma/*drug therapy
Administration, Oral ; Adult ; Consensus ; Delphi Technique ; Female ; Humans ; Male ; Middle Aged ; Practice Guidelines as Topic
Contributed Indexing:: Investigator: M Al-Ahmad; KS Babu; P Bakakos; S Ball; E Bel; L Bjermer; FX Blanc; F Blasi; A Bourdin; T Brown; L Brussino; H Burhan; J Calvert; M Caminati; R Campos Cerda; GW Canonica; C Caruso; D Cataldo; P Chanez; P Chanson; K Chapman; R Chaudhuri; C Chenivesse; S Choudhury; G Christoff; LP Chung; D Clairelyne; I Clifton; B Cochrane; S Colantuono; L Cosmi; R Costello; A Côté; N Crimi; MG Crooks; M D'Amato; MS De Gennaro; M Debono; S Del Giacco; P Dennison; A Deschildre; A Detoraki; G Devouassoux; A Didier; D Dorscheid; T Fardon; S Faruqi; JM FitzGerald; M Gaga; S Genova; P Gibson; R Gore; L Guilleminault; M Gurnell; D Hamerlijnck; N Hanania; L Heaney; E Heffler; DD Hernandez Colin; M Hew; F Hoyte; M Humbert; M Idzko; C Jenkins; P Kauppi; K Kostikas; P Kuna; M Kupczyk; I Kupryś-Lipińska; M Labor; D Langton; M Latorre; L Lehtimäki; R Louis; S Loukides; NL Lugogo; G Mahay; B Mahboub; M Masoli; J Maspero; K Meeran; F Menzella; A Menzies-Gow; P Middleton; M Milanese; PD Mitchell; A Mohan; P Paggiaro; NG Papadopoulos; AI Papaioannou; I Pavord; R Peché; C Pelaia; G Pelaia; DW Perng; P Pfeffer; C Pilette; C Pison; D Plavec; TA Popov; S Popović-Grle; AS Powlson; F Puggioni; H Reddel; CK Rhee; N Roche; H Rupani; I Sabroe; K Samitas; P Santus; F Schleich; C Selmi; G Senna; M Sherlock; S Siddiqui; A Smith; A Spanevello; C Taillé; C Taube; A ten Brinke; N Tudoric; A Tunsäter; C Ulrik; J Upham; E Van Ganse; B Walker; E Wang; P Wark; M Wechsler; T Winders; E Zervas
Keywords: adrenal insufficiency; adverse effects; biological treatments; shared decision-making
Substance Nomenclature:: 0 (Adrenal Cortex Hormones)
Entry Date(s):: Date Created: 20201028 Date Completed: 20210426 Latest Revision: 20210426
Update Code:: 20240105
DOI:: 10.1164/rccm.202007-2721OC
PMID:: 33112646
: Czasopismo naukowe

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.

Comment in: Am J Respir Crit Care Med. 2021 Apr 1;203(7):795-796. (PMID: 33211979)

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