Asthma and corticosteroids “odi et amo”: how to deal with it?

Asthma is a chronic, heterogeneous respiratory disease that affects more than 300 million individuals worldwide and is responsible for substantial morbidity, mortality and healthcare burden. Chronic airway inflammation plays a central role in symptom expression, disease progression, and response to therapy. Corticosteroids, both inhaled and systemic, are the cornerstone of asthma treatment. However, it is well known that the use and abuse of systemic corticosteroids is almost invariably associated to the development of significant acute and chronic adverse events. Epidemiological data report that despite the availability of new target therapy, e.g., biologics, in real practice systemic steroids are still overused, and in this review, we highlight strategies 1) to identify and screen patients at risk of developing corticosteroids adverse events and 2) to reduce them.