Are systemic corticosteroids needed for all asthma exacerbations?

Asthma exacerbations are potentially life-altering crises for many patients [1]. Despite this pivotal impact in the life cycle of asthma, the treatment for exacerbations has not changed in nearly 50 years. In particular, the therapeutic approach to exacerbations has not incorporated directions to identify which patient is most likely to benefit from the current cornerstone of treatment – systemic corticosteroids (SCS). Despite extensive clinical experience and research, major gaps exist on how to best utilise SCS during an asthma exacerbation, including the optimal therapeutic dose, the ideal duration of treatment to restore baseline conditions, and precise knowledge of the dominant and beneficial anti-inflammatory effects that SCS provide in the airways during an exacerbation [2]. An answer to part of this unmet need might begin with the recognition that patterns of airway inflammation in asthma are heterogeneous and contribute to predicting the efficacy of treatment [3]. At present, every asthma exacerbation is treated similarly with SCS and with the same expectancy of a positive response. Systemic corticosteroids are more effective in the treatment of asthma exacerbations in the presence of T2 inflammation https://bit.ly/3DDCGF4