Systemic Impact of Prolonged Corticosteroid Therapy in Asthma Patients: a Case Series
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Abstract
Objectives: To determine, in patients with bronchial asthma and prolonged use of systemic corticosteroids (CS), the endocrinological impact on the hypothalamic-pituitary-adrenal axis and the clinical impact on target organs.
Methods: Retrospective analysis of medical records of asthmatic patients treated with systemic CS and referred to pulmonology clinics. They were evaluated by an endocrinologist to assess the clinical and endocrinological impact. Conventional statistical methods were used.
Results: A total of 12 patients were included (66.6% female, median age 41 years), of which 66.6% had childhood-onset asthma and 33% were smokers. Only 8% had controlled asthma with a median ACT score of 13. CS use averaged 24 months, with baseline cortisol abnormalities in 100% of patients. The adrenal axis recovered in 75% of cases after 12 months. Three patients (25%) did not recover adrenal function. Clinically, there was pyrosis/reflux (66.6%), hypertension (41.6%), osteopenia/osteoporosis (33.3%), obesity (33%), and diabetes, glucose intolerance, or cataracts in 8%.
Conclusion: Prolonged CS use in poorly controlled asthmatic patients led to adrenal insufficiency in all cases, with recovery in 75% after one year. Significant clinical impacts were observed in cardiovascular, bone and gastrointestinal systems. It is recommended to educate patients and healthcare providers about the deleterious effects of CS, to improve adherence to preventive treatment and consult endocrinology when considering discontinuing it.
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