COVID-19 has brought into sharp focus the importance of health and, more importantly, the impact of poor health on individuals and on society.The pandemic is causing a fundamental reconsideration of how health care is delivered. Some reform has been out of necessity; adapting services in order to keep people away from hospital settings and potential infection exposure. But this is not, nor should it ever be, our sole focus. Instead, important work is being undertaken to build a ‘new normal’ across many aspects of society, and we in the health care sector must take a leading role in this process.
Critically, our new normal must ensure that across the world, established best practices and clinically validated treatment options are routinely adopted and applied. In so doing, we can rapidly advance progress towards better outcomes and experiences for patients, and greater value for the society in which we live.
Severe asthma directly impacts more than 30 million people worldwide and their condition can mean a life of frequent, severe attacks and reduced lung function.
One area in clear need of such transformation is severe asthma, where the over-reliance on oral corticosteroids (OCS) can cause significant health risks for patients, as well as unnecessary strain on health systems. Severe asthma directly impacts more than 30 million people worldwide and their condition can mean a life of frequent, severe attacks and reduced lung function. As a consequence, their lives are disrupted by regular visits to the emergency room, hospital admissions, and the potentially debilitating adverse effects of long-term exposure to OCS. This undoubtedly has implications on the wider health system, with greater OCS exposure being associated with increased health care costs and resource utilization.
Reliance on the use of OCS, widely acknowledged to bring substantial negative impacts for the patients using them and for the wider health system, is in stark contrast to such ambitions for a new normal.
There is no doubt that OCS play an important role in the management of asthma, particularly in the management of acute exacerbations and for those for whom treatment alternatives are either not available or not appropriate. But many people with asthma, particularly severe asthma, have a complicated relationship with OCS, with some referring to them as a ‘frenemy’. OCS can save their lives during acute episodes, but they can also have a detrimental impact on quality of life in both the short and longer term. The negative impacts of using OCS are well documented. Some people have short-term psychological effects such as anxiety, irritability and depression, and there can also be long-term health impacts associated with cumulative use of OCS such as diabetes, osteoporosis, glaucoma and cardiovascular disease.
Many people with asthma, particularly severe asthma, have a complicated relationship with OCS, with some referring to them as a ‘frenemy’.
Due to these widely acknowledged side effects, and advances in care, there is clinical support for a shift away from a reliance on OCS in the treatment of severe asthma. A patient charter, developed by global experts in the disease area, makes it clear that people with severe asthma “deserve not to be reliant on OCS”. In addition, global guidelines are in place which relegate the use of OCS for acute exacerbations only and position them as a last-resort option for maintenance or long-term use in severe asthma.
Despite this, OCS continue to be widely prescribed in people with severe asthma worldwide, with long-term or frequent acute OCS use reported in 15 percent to 64 percent of people with severe asthma globally. In fact, potential OCS-induced morbidities, which include hypertension, cardiovascular disease and diabetes, have been identified in 93 percent of people with severe asthma.
There is clinical support for a shift away from a reliance on OCS in the treatment of severe asthma.
In other conditions like lupus and rheumatoid arthritis — where OCS has been historically used — care advances, and concerns around the adverse effects of long-term use of OCS have resulted in significant reductions in use. Yet it is clear that OCS use in asthma is not reducing at the same pace.
This could be because a clinical legacy of limited alternative treatment options to OCS means there are often low expectations among patients and clinicians alike about the prospect of moving beyond OCS. But it is also true that in many countries, decisive political action has not yet been taken to challenge existing approaches and, often, reporting is such that the problem is hard to evaluate.
At the core of our response to COVID 19 must be a renewed focus on enabling the long-term health of individuals; and doing so in a way that sustainably mitigates the burden on already-stretched health systems. To achieve this, we must ensure clinically-validated recommendations are put into practice.
Severe asthma is a prime example of where reform and prioritization can make a major difference.
Severe asthma is a prime example of where reform and prioritization can make a major difference to patient outcomes, while also positively impacting long term health care costs. This will only be possible if policymakers apply practical steps to scrutinize current care gaps and enable the adoption of established best practices.
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Sponsored by ASTRAZENECA. Veeva ID: Z4-27437| Date of preparation: October 2020