Corticosteroid Therapy: a Double-Edged Sword. An ALAT Position Statement
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Abstract
Background: For more than seven decades, systemic corticosteroids have been a cornerstone in the treatment of chronic inflammatory diseases, particularly bronchial asthma. However, their widespread and often indiscriminate use has raised growing concern because of their association with a broad spectrum of systemic adverse effects and their clinical and economic impact on healthcare systems.
Objective: To critically analyze the current evidence on patterns of systemic corticosteroid use, their safety profile, and their clinical and economic impact, with particular emphasis on asthma management, and to provide recommendations for a safer and more rational use of these agents.
Methods: This position paper was developed by the Asthma Department of the Latin American Thoracic Association (ALAT), based on a narrative review of the available literature and expert consensus.
Results: Epidemiological data show a high global prevalence of use, particularly among patients with asthma and other chronic respiratory diseases. Even short courses or relatively low cumulative doses increase the risk of serious adverse events —infections, cardiovascular complications, osteoporosis, metabolic disorders, and hypothalamic–pituitary–adrenal axis suppression—, contributing to greater morbidity, mortality, and costs. In severe asthma, emerging evidence has driven a paradigm shift aimed at minimizing exposure through rational prescribing, optimization of maintenance therapy, and targeted biologic therapies.
Conclusions: Although systemic corticosteroids remain essential, their excessive or inappropriate use imposes a substantial clinical and economic burden. Rational prescribing, active monitoring of adverse effects, and early adoption of steroid-sparing therapies are key approaches to improving treatment safety, particularly in severe asthma.
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