Am J Respir Crit Care Med. 2020 Oct 28. doi: 10.1164/rccm.202007-2721OC. Online ahead of print.
RATIONALE: There is a need to minimize oral corticosteroid use in patients with asthma to prevent their costly and burdensome adverse effects. Current guidelines do not provide recommendations for oral corticosteroid tapering in patients with asthma.
OBJECTIVES: To develop expert consensus on oral corticosteroid tapering among international experts.
METHODS: A modified Delphi method was used to develop expert consensus statements relating to oral corticosteroid use, tapering, adverse effects, adrenal insufficiency, and patient-physician shared decision-making. Initial statements proposed by experts were categorized, filtered for repetition, and presented back to experts over three ranking rounds to obtain consensus (≥70% agreement).
MEASUREMENTS AND MAIN RESULTS: 131 international experts participated in the study and 296 statements were ranked. Numerous recommendations and guidance regarding appropriate oral corticosteroid use were established. Experts agreed that oral corticosteroid tapering should be attempted in all patients with asthma receiving maintenance oral corticosteroid therapy, with personalization of tapering rhythm and speed. The importance of recognizing individual adverse effects was also established; however, a unified approach to the assessment of adrenal insufficiency was not reached. Shared decision-making was considered an important goal during the tapering process.
CONCLUSION: In this Delphi study expert consensus statements were generated on oral corticosteroid use, tapering, adverse effects screening, and shared decision-making, which may be used to inform clinical practice. Areas of non-consensus were identified, highlighting uncertainty among the experts around some aspects of oral corticosteroid use in asthma, such as adrenal insufficiency, which underscores the need for further research in these domains.