TABLE 1

Statements assessed by the expert panel members

PropositionEstimated quality of evidence#Level of conviction[Refs]
All OCS treated asthma patients should be referred to an expert centre able to propose multidisciplinary assessment and access to innovationsModerateVery high[5, 85–87, 105–107, 143]
We recommend computing the frequency of steroid burstsHighHigh[5, 28, 29, 98, 99, 124, 146, 147]
We recommend systematic supervised OCS tapering using objective markers of disease activityLowModerate[32, 33, 132, 148]
We recommend computing the cumulative annual dose of OCS and including ICSModerateHigh[28–31, 135]
We recommend establishing equivalence between ICS and OCS in children and adults (systemic distribution of ICS)LowHigh[5]
We recommend communicating to all the community that a 1 g cumulative yearly dose is a red flag threshold for referralNoneVery high
We recommend a minimal checklist for assessing side-effects and comorbidities in OCS users, including: growth, weight, BMD and FRAX risk score; Hb1ac or glycaemia; blood pressure and cardiovascular risk score (CHADS2)ModerateModerate[44, 118, 126, 128, 142]
Adrenal insufficiency should be systematically screened and treated while tapering and/or stopping OCSHighHigh[132]
We recommend considering a switch of biologic if OCS weaning is not achieved in 12 months (unless indicated for adrenal insufficiency)NoneHigh
Specificities in children and teenagers
 We suggest that two OCS bursts or more per year in children is a case for referralHighHigh[89, 91, 97, 99, 102, 125, 126, 145]
 Considering the availability of biologics, we recommend that maintenance treatment with OCS remains an exception for children and teenagersNoneHigh
 We recommend checking for OCS side-effects, furthermore when OCS bursts are frequentHighHigh[89, 91, 97, 99, 102, 125, 126, 145]
 We support studies evaluating new treatment strategies including early intervention with anti-IgE, other biologics and nonsteroid-based alternative therapies which may improve clinical and functional outcomes, and spare OCS useLowVery high[93, 103]

#: graded according to Oxford evidence-based medicine [149]; : ideal clinical and biological markers for supervising OCS tapering are unknown. OCS: oral corticosteroids; ICS: inhaled corticosteroid; BMD: bone marrow density; FRAX: Fracture Risk Assessment Tool; Hb1ac: glycated haemoglobin; Ig: immunoglobulin.