Corticosteroid stewardship in asthma: from individual prescribers to system-level change

PURPOSE OF REVIEW: In this review, we discuss the under-recognition of harms associated with corticosteroid overuse in asthma and highlight the concept of corticosteroid stewardship as an approach to address these harms. RECENT FINDINGS: Adverse health effects of chronic systemic steroids to treat asthma are well known in the medical community. There is less familiarity with recent data showing similar harms from repeated short courses of systemic corticosteroids (SCS) to treat asthma flares and long-term use of high dose inhaled corticosteroids (ICS). In this review, we summarize recent advances in our knowledge of adverse effects of corticosteroid overuse in asthma, highlight recent calls for corticosteroids stewardship in asthma care, and describe effective systems-based strategies used to reduce corticosteroid overuse in asthma. SUMMARY: Those involved in primary care, acute care, and specialty care of asthma may use this review for an updated understanding of corticosteroid associated harms, and as a guide to both individual practitioner and health systems-based approaches to corticosteroid stewardship.