LAUSR

BACKGROUND Oral corticosteroid (OCS) use in severe asthma remains all too common despite advances in asthma treatment. Use of OCS is associated with significant toxicity that can have lasting adverse impact on patient's overall health. In recent years, monoclonal antibodies have been developed that both reduce the rate of OCS-treated exacerbations and reduce OCS requirements in patients with oral corticosteroid-dependent asthma. SCOPE OF REVIEW We offer strategies to prevent and best manage endocrine complications associated with OCS use and provide guidance on OCS dose management after introduction of steroid-sparing therapies. HOW I DO IT?: 1. We identify OCS-dependent patients and assess for co-morbidities including bone health, glycemic control and adrenal function. 2. We begin attempts at OCS dose optimization even prior to or soon after introducing a steroid-sparing biologic therapy. 3. We taper OCS using explicit criteria for asthma control. 4. We assess HPA axis integrity once physiologic dose of OCS is achieved to guide further rate of OCS taper. 5. We manage corticosteroid-related co-morbidities as detailed in this review.