Severe asthma with and without long-term oral corticosteroids (OCS): A comparison of disease severity and baseline characteristics

<bold>Background:</bold> Oral steroids are still regularly used for treatment of patients with severe asthma. Still there is scarce data on the differences between severe asthma patients on OCS long term therapy compared to patients without regular OCS treatment. <bold>Methods:</bold> Data from 3134 patients with severe asthma from the German Asthma Net's registry were evaluated and 977 patients with long term OCS therapy (OCS group) and 2157 patients without OCS (nonOCS) were compared. <bold>Results:</bold> There were no significant differences in BMI, asthma duration, or smoking habits between the two groups. Patients in the OCS group received a median dose of 10 mg prednisolone and were more symptomatic and experienced significantly more exacerbations compared to nonOCS patients. Asthma control was poorer in the OCS group compared to nonOCS. In addition, OCS group patients had lower median FEV₁, Tiffeneau index, and higher residual volume compared to nonOCS. Prevalence of chronic sinusitis was higher in OCS group (52% vs. 41%, p<0.0001). In addition, OCS group patients exhibited higher FeNO levels (55 ppb vs. 46 ppb, p=0.0009), whereas eosinophil counts were not different and IgE levels tended to be lower. nonOCS patients were more likely to have allergic asthma compared to OCS group patients. OCS group patients received higher doses of ICS (BDP 1400 µg vs. 1000 µg, p<0.0001). Treatment with biologic was equally common in both groups. <bold>Conclusion:</bold> There are differences between OCS group and nonOCS. OCS group patients exhibit more severe disease characteristics and poorer asthma control. These findings highlight the need for optimized treatment strategies in this group.