Asthma UK: switch from steroid to biologic treatments

Charity warns of the hidden toll of repeated steroid tablets for Asthma when new “wonder” biologic treatments are available.

• Repeated, high-dose steroid tablets can impair the immune system, making people more vulnerable to respiratory infections and cause toxic side-effects1
• Two or more courses of steroid tablets in a year to treat asthma symptoms should trigger a review and a referral if patient’s asthma is not controlled by their preventer medication2.
• Preventer inhalers, which generally contain a low dose of steroids, are considered safe and help prevent asthma attacks from happening in the first place3
• Asthma UK has created an online checker so adults with asthma can find out if they need to see a GP now to improve their condition or get a specialist referral.

Asthma UK has launched a major campaign to help identify people with uncontrolled asthma – stuck on repeated steroid tablet treatment known to compromise the immune system leading to an increased risk of infection and causing toxic side-effects – so that they can be urgently assessed and considered for referral for life-changing new treatments.

Every year, an estimated 1.3 million adults with asthma need steroid tablets, essential life-saving drugs used to treat a severe asthma attack or a flare up in symptoms.4 However, if taken repeatedly, or for a long period, they can cause debilitating side-effects including diabetes and obesity and also increase the risk of serious illness from respiratory infections, including coronavirus.5 They can also weaken the body’s ability to defend against illnesses such as colds, flu and pneumonia, which can all cause life-threatening asthma attacks.6 Although research is still emerging, this may also be true for Covid-19.

New analysis from Asthma UK’s survey of more than 3,000 people with asthma shows that people who have taken steroid tablets in the last year experienced the following side-effects:

• An estimated 500,000 people have experienced weight gain and insomnia
• A third of people have experienced mental health issues, including mood swings and suicidal thoughts, an estimated 425,000 people
• 1 in 10 told us that they have had osteoporosis
• An estimated 100,000 have experienced hair loss

For 1 in 5 taking steroid tablets has affected their career, including career choice, having to take time off work, work part-time or give up working.7

Asthma UK is now campaigning for increased referrals and has developed a new online tool to help people with asthma get on top of uncontrolled symptoms, work out whether they need to ask their doctor for extra help or a referral, and ask for specialist support they might need. Some people with severe asthma will be eligible for biologics, hailed as a “game-changer” by those suitable for the treatment. Biologics are genetically engineered proteins that target specific parts of the immune system that fuel inflammation. Clinical trials found that for those with severe asthma, using biologics can reduce asthma attacks by up to half and can reduce and even stop the need for steroid tablets.

Repeated steroid tablet treatment could be a sign that someone has severe asthma, the most life-threatening form of the condition which currently affects an estimated 200,000 people; however, tens of thousands are yet to be diagnosed. The National Review of Asthma Deaths (2014), which investigated causes of asthma deaths found that over a third had severe asthma – that is, they had been recently hospitalised for their asthma or prescribed high levels of asthma medicines.8

Asthma UK says that following NHS guidance, if someone with asthma is prescribed two or more courses of steroid tablets in a year which aren’t working they should be urgently referred to a specialist so they can get the care they need and be assessed for access to alternative treatments such as biologics which can be life-changing for patients.

With winter being the deadliest season for people with asthma and services predicted to be stretched to breaking point during the pandemic, it’s even more vital that people with uncontrolled symptoms and suspected severe asthma are assessed and put on the right treatments, helping to keep them out of hospital.

Too few patients are being referred to specialist centres which means they are not getting a diagnosis or an opportunity to try these new treatments, available on the NHS. The charity estimates that as many as 46,000 people eligible for these treatments are still missing out and says a complacency around the seriousness of asthma and a lack of awareness and about these new drugs could be why the uptake of these transformative treatments has been sluggish.9

Dr Andrew Whittamore, Clinical Lead for Asthma UK and the British Lung Foundation and a practising GP, said:

“Severe asthma can have a colossal impact on the quality of life of those affected, however hope is on the horizon and new, potentially life-changing treatments are available on the NHS. Without a referral, people with suspected severe asthma can end up on repeated courses of steroid tablets which can weaken the body’s immune defences and put an added strain on people’s mental and physical health.

“If someone’s asthma symptoms cannot be controlled or they have had more than two flare-ups requiring steroid tablets in the last year, healthcare professionals should consider referring their patient to a specialist asthma clinic as they could have severe asthma and if eligible, could benefit from these new treatments, significantly reducing or stopping the need for steroid tablets.

“It is essential that people with asthma do not stop taking any treatment as prescribed by their GP, any changes must be in consultation with a healthcare professional. Asthma UK is encouraging anyone who is concerned about their symptoms to try out a new online tool so people can find out if they need to see their GP to either improve their asthma management or get a referral to a specialist centre. For more information, visit: www.asthma.org.uk/severeasthma”

Melanie Mott, 37 from Loughborough, is an office worker for a nursery and was diagnosed with severe asthma seven years ago after seeking out a private referral following repeated trips to her GP. Melanie is now under NHS care, home administering her treatment.

Melanie said: “When I was diagnosed with severe asthma by a specialist, treatment options were non-existent, and I had to take strong steroid tablets every day to manage my symptoms but suffered horrific side-effects. Within two years, I put on 5 stone, and I was bursting out of my clothes and couldn’t walk far without losing my breath. I couldn’t get out of bed or shower without my husband helping me and my friends didn’t recognise me when I was out and about. I went from being able to hike, ski and swim to using a mobility scooter to get around. I’d have a panic attack just looking at the stairs and think I can’t get up them.

“It was soul-destroying, and it took a real toll on my mental health and I was too ill to work. At the time, I was also juggling all of this with being a mum to two young boys who I couldn’t even play with in the park, I had to give up work and it put a major strain on my marriage.

“Things started to look-up when I was trialled on a ground-breaking new biologic treatment which I am still taking today. It has turned my life around and given me the confidence to be more active and I’m back working again. There are now some amazing treatments out there but it’s heart-breaking to know that there are still thousands of people who have fallen through the cracks and could benefit from these wonder drugs but haven’t been referred for specialist help.”

Dr James Calvert, Respiratory Consultant South West Asthma Network/North Bristol NHS Trust, said:

“The impact of severe asthma is not limited to asthma symptoms and acute attacks, it disrupts every aspect of a patient’s life, affecting their home, work and social life. Many people with suspected severe asthma feel powerless because of chronic symptoms and repeat steroid tablet treatments causing some to develop serious health complications including osteoporosis, diabetes and severe weight gain, leading to mobility issues. I have witnessed first-hand the transformative impact of biologic treatments, with some patients describing it as a ‘wonder drug’, radically enhancing their quality of life, helping them to live more normal, active lives free from toxic side-effects.

“People with suspected asthma need to get a referral, without one they cannot benefit from this new generation of therapies which have seen fantastic uptake for the treatment other chronic conditions including rheumatoid arthritis, where steroid therapy is no longer over-used. It’s about time severe asthma got the same treatment.”

References: 

1. NHS.uk, Side-effects of steroids, January 2020
2. Primary Care Respiratory Society (PCRS), Poorly controlled and severe asthma: triggers for referral for adult or paediatric specialist care, 2019; NHS England, Specialised respiratory services (adult) – severe asthma.
3. Asthma UK, Preventer inhalers, April 2018
4. European Respiratory Journal, Oral corticosteroid prescription patterns for asthma in France, Italy and the UK, June 2020.  This study estimates 30% of people with asthma in the UK needed oral steroids in the last year. We applied the proportion (30%) to the number of adults with asthma in the UK (4.5 million) to get to ~1.3million.
5. BMJ, Covid-19: Why are age and obesity risk factors for serious disease, October 2020; The Lancet, Diabetes and Endocrinology, Covid-19 in people with diabetes: understanding the      reasons for worse outcomes, July 2020;  Imperial Healthcare NHS Trust, Does immunosuppressive treatment increase the risk of contracting COVID-19 or developing severe symptoms, April 2020; NHS.uk, Who’s at higher risk from coronavirus, November 2020.
6. Asthma UK, Colds and flu as asthma triggers, September 2020;  Asthma UK, Chest infections and asthma, November 2020.
7. Asthma UK, Do no harm: safer and better treatment options for people with asthma, pp24-25, November 2020. To get these figures we have extrapolated onto the 1.3million people with asthma needing oral steroids in the last year.
8. Royal College of Physicians, Why asthma still kills: The National Review of Asthma Deaths (NRAD), May 2014
9. Asthma UK, Do no harm: safer and better treatment options for people with asthma, p11,  November 2020.

About Asthma UK:

Asthma UK’s mission is to stop asthma attacks and, ultimately, cure asthma. We do this by funding world leading research, campaigning for improved care and supporting people to reduce their risk of a potentially life-threatening asthma attack. We are entirely funded by voluntary donations. For further information, please visit: asthma.org.uk.