Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Thorax. 2016 Apr;71(4):339-46. doi: 10.1136/thoraxjnl-2015-207630. Epub 2016 Jan 27.


Objective: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.

Design: Cross-sectional observational study.

Setting: The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.

Participants: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).

Main outcome measures: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.

Results: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.

Conclusions: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

Keywords: Asthma; Drug reactions.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Body Mass Index
  • Cataract / chemically induced
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / chemically induced*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Duodenal Ulcer / chemically induced
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Obesity / chemically induced*
  • Obesity / epidemiology
  • Osteoporosis / chemically induced*
  • Osteoporosis / epidemiology
  • Prevalence
  • Quality of Life
  • Registries
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution
  • Sleep Apnea, Obstructive / chemically induced
  • Stomach Ulcer / chemically induced
  • United Kingdom / epidemiology


  • Glucocorticoids