Factors Associated With Systemic Corticosteroid Use in Patients With Asthma: A Real-Life Study

Abstract

Introduction Asthma is a chronic inflammatory respiratory disease that affects a substantial portion of the global population. Systemic corticosteroids (SCS) are generally reserved as a last-line therapy for severe asthma or acute exacerbations; however, their extended use is associated with serious adverse effects, including metabolic and musculoskeletal complications. In Mexico, documentation on SCS use among individuals with asthma is limited, highlighting the need to identify factors linked to their overuse to reduce long-term harm. Materials and methods A multicenter ambispective study was conducted in secondary and tertiary care hospitals in Mexico between June 2023 and June 2024. A total of 152 asthma patients were included, and clinical and laboratory data related to SCS use were collected. Variables analyzed included asthma severity, endotype, comorbidities, and the number of exacerbations in the past 12 months. Data were collected using standardized questionnaires and analyzed using descriptive and inferential statistics. Results A total of 152 patients were included in the final sample; 74 (48.7%) of the patients used SCS in the past 12 months. SCS use was more frequent in patients with severe asthma (81.8%) and eosinophilic endotype (83.3%), and these differences were statistically significant (p<0.05). Patients with a recent asthma diagnosis (<1 year) also exhibited high SCS use (90%), although this was not significantly different from those diagnosed for more than five years. Among comorbidities, all patients with nasal polyposis used SCS (p<0.05), whereas passive smoking and obesity showed no significant associations with SCS use. The median eosinophil count was higher in SCS users (208 vs. 114; p<0.05), reinforcing the relationship between eosinophilic inflammation and increased SCS use. Conclusions This study identifies factors associated with SCS use in asthma patients, including disease severity, eosinophilic inflammation, and nasal polyposis. These findings highlight the need for more specific therapeutic strategies, such as biologics, to reduce SCS dependency and associated adverse events. Despite certain limitations, the results highlight the importance of early diagnosis and effective asthma management to optimize treatment outcomes and minimize long-term risks.