Age and Sex Associations with Systemic Corticosteroid-Induced Morbidity in Asthma

J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):2014-2023.e2. doi: 10.1016/j.jaip.2018.04.008. Epub 2018 Apr 21.


Background: Treatment of severe asthma may include high-dose systemic corticosteroid therapy, which is associated with substantial comorbidity. There is evidence to suggest that this burden is not evenly distributed across age, sex, and corticosteroid exposure levels.

Objective: To examine the associations between age, sex, comorbidity, and patterns of health care cost across groups differentiated by corticosteroid exposure.

Methods: Patients with severe asthma (n = 808) were matched by age and sex with patients with mild/moderate asthma (n = 3975) and nonasthma control subjects (n = 2412) from the Optimum Patient Care Research Database. Regression analysis was used to investigate the odds of a number of corticosteroid-induced comorbidities as it varied by cohort, age group, and sex. Prescribed drugs and publicly funded health care activity were monetized and annual costs per patient estimated.

Results: Patients aged 60 years or younger with high oral corticosteroid (OCS) exposure had greater odds of osteopenia, osteoporosis, glaucoma, dyspeptic disorders, chronic kidney disease, cardiovascular disease, cataracts, hypertension, and obesity (P < .01) relative to those with mild/moderate asthma (low OCS exposure) as well as to those with no asthma. This difference in odds was much less evident in older patients. Sex-related differences for the odds of most comorbidities related to high-dose OCS were also observed. This differential pattern of comorbidity prevalence was reflected in mean health care costs per patient per year.

Conclusions: Results demonstrate important differential prevalence of corticosteroid-induced morbidity by age and sex, which is paralleled by differences in health care costs. This is important for clinicians in better understanding the risks of placing different age groups or sexes on systemic corticosteroids.

Keywords: Age; Asthma; Comorbidity; Corticosteroid; Economic; Sex.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Age Factors*
  • Aged
  • Asthma / drug therapy
  • Asthma / economics
  • Asthma / epidemiology*
  • Cohort Studies
  • Comorbidity
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Female
  • Health Care Costs
  • Humans
  • Ireland / epidemiology
  • Male
  • Middle Aged
  • Osteoporosis / epidemiology*
  • Renal Insufficiency, Chronic / epidemiology*
  • Severity of Illness Index
  • Sex Factors*


  • Adrenal Cortex Hormones