Oral corticosteroid exposure and adverse effects in asthmatic patients

J Allergy Clin Immunol. 2018 Jan;141(1):110-116.e7. doi: 10.1016/j.jaci.2017.04.009. Epub 2017 Apr 27.


Background: Significant adverse effects (AEs) have been associated with continuous exposure to oral corticosteroids (OCSs). The potential association with intermittent exposure is unknown.

Objective: We sought to assess the association between OCSs and AEs based on the number of OCS prescriptions.

Methods: This was a retrospective cohort study of asthmatic patients 18 years and older in the 2000-2014 MarketScan data set. Propensity score matching was used at baseline (12 months before the index date: first OCS use). Logistic regression was used to examine the association between OCSs and new incident AEs (either combined or individual) controlling for covariates. Follow-up continued for 24 months minimum and 10 years maximum after the index date.

Results: There were 72,063 and 156,373 subjects in the OCS and no OCS cohorts, respectively. Subjects taking 4 or more OCS (1-3) prescriptions within the year had 1.29 (1.04) times the odds of experiencing a new AE within the year. Each year of exposure to 4 or more OCS prescriptions (current and past) resulted in 1.20 times the odds of having an AE in the current year. Exposure to 4 or more prescriptions was associated with significantly greater odds of AEs for osteoporosis, hypertension, obesity, type 2 diabetes, gastrointestinal ulcers/bleeds, fractures, and cataracts (odds, 1.21-1.44 depending on the AE).

Conclusion: Although previous research has documented the deleterious effect of continuous OCS exposure in patients with severe asthma, our results suggest that each OCS prescription might result in a cumulative burden on current and future health regardless of dose and duration. OCS-sparing strategies are extremely important to improve patient outcomes.

Keywords: Oral corticosteroids; adverse effects; burst therapy; severe asthma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects*
  • Adult
  • Asthma* / drug therapy
  • Asthma* / epidemiology
  • Cataract / chemically induced
  • Cataract / epidemiology
  • Diabetes Mellitus, Type 2 / chemically induced
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • Fractures, Bone / chemically induced
  • Fractures, Bone / epidemiology
  • Gastrointestinal Hemorrhage / chemically induced
  • Gastrointestinal Hemorrhage / epidemiology
  • Humans
  • Hypertension / chemically induced
  • Hypertension / epidemiology
  • Male
  • Middle Aged
  • Obesity / chemically induced
  • Obesity / epidemiology
  • Osteoporosis / chemically induced
  • Osteoporosis / epidemiology
  • Retrospective Studies


  • Adrenal Cortex Hormones