Invited Speaker

Alternatives to Oral Corticosteroids in Gina Step V Asthma Patients
Christian Domingo


Asthma is a problem worldwide, with an estimated 300 million affected individuals. Based on the application of standardized methods to measure the prevalence of asthma and wheezing illness in children and adults, it appears that the global prevalence of asthma ranges from 1% to 18% of the population in different countries. The incidence, morbidity and mortality of the condition have increased over the last fifty years despite the development of new anti-asthmatic drugs. Fewer than 1% of the asthmatic population are steroid-dependent, but these patients consume most of the time and resources at asthma units.

The consensus documents published by professional societies all support a stepwise therapeutic approach for asthma. However, patients who require frequent or continuous oral corticosteroid administration have received little attention. Due to the severe side-effects of corticosteroids when administered over long periods or at high doses, many drugs have been assessed in the search for a possible corticosteroid-sparing agent. Recently, the update of the GINA introduced for the first time a drug –Omalizumab- as an alternative to oral corticosteroids in patients included in step five. Other alternatives include immunosuppressive drugs, among which methotrexate has been found to offer the best benefit/risk ratio. However, it has been used with caution by pulmonologists since its long-term tolerance has not been clearly established until recently.
This talk will focus on the alternative treatments to oral glucocorticosteroids in GINA step V asthma patients.