Since their introduction many decades ago, systemic
corticosteroids have become a mainstay treatment for
asthma. Despite being a highly effective
therapy,
corticosteroids can cause significant adverse effects in patients. This results in a "double hit" for some patients as they suffer the burden of disease as well as the burden of treatment-induced morbidity.This article aims to raise awareness of the potential, harmful side effects of prolonged or repeated exposure to systemic
corticosteroids in
asthma. It also highlights the importance of referral of the appropriate patients with
asthma from primary care for specialist assessment once other considerations such as adherence,
inhaler technique and co-morbidity have been evaluated. We propose a simple decision step that may help busy primary care physicians and general practitioners to identify patients who could benefit from specialist assessment.Our decision step suggests that a patient with
asthma should be reviewed at least once by an
asthma specialist if he/she (i) has received ≥2 courses of oral
corticosteroids in the previous year;
asthma remains uncontrolled despite good adherence and
inhaler technique; or (ii) has attended an emergency department or was hospitalized for
asthma care.Such referral could facilitate wider access to diagnostic tools, in-depth assessment of confounding comorbidities, and non-
corticosteroid-based
therapies as needed, which may be unavailable in primary practice.