Global perceptions and practices of systemic corticosteroid use in asthma and COPD management

Background: Asthma and chronic obstructive pulmonary disease (COPD) are prevalent worldwide, and systemic corticosteroids (SCS) are commonly used in primary care. There is limited data on prescribing practices and perceptions of healthcare providers worldwide. Objective: To determine the perceptions and practices of primary care prescribers and community pharmacists regarding SCS use in the management of adult and paediatric asthma and COPD. Methods: A questionnaire on the use of SCS (oral or injectable) in the management of asthma and COPD was developed by an international primary care expert group. A cross-sectional survey was then conducted online in 41 countries. Results: 376 participants (314 prescribers and 62 pharmacists) responded, response rate 63%. Key findings include: - 69% of prescribers prescribed SCS for asthma and 63.6% for COPD. - For asthma, SCS were mainly used for acute exacerbation. About 2/3 would use it for severe asthma, without access to biologics and 1/3 would use it for uncontrolled asthma or for long term treatment when other options have not been effective. - For COPD SCS were used mainly for exacerbation, 1/6 would use it for long term management. - About 50% would provide an action pack including SCS for emergency home use for asthma/COPD. - 60% of prescribers and 67% of pharmacists believed that SCS were overused due to prescriber knowledge gaps, ease of use, limited access to inhaled treatments and lower cost, compared to other medicines. Conclusions: The findings indicate a need for standardised guidelines and targeted initiatives focusing on improving education of prescribers and pharmacists about appropriate treatments. In addition, improving patient education about SCS use and advocating for better access to appropriate therapies may play a role in changing this scenario. Implications: Implementing these measures can optimise appropriate treatments for asthma and COPD, reduce SCS overuse, and improve patient outcomes globally.