Chronic Corticosteroid Use Harms Health, Increases Cost for Patients With Asthma

The chronic use of oral corticosteroids (OCS) has detrimental consequences for health outcomes, productivity, life expectancy, and health care costs among patients with asthma, according to a study in the Journal of Allergy and Clinical Immunology: Global.¹

“Asthma affects over 25 million people in the United States, with asthma-related health care costs estimated at almost $82 billion annually; these costs are predicted to grow in the future, in particular if the prevalence of uncontrolled asthma does not improve,” according to authors of the study. “The Global Initiative for Asthma guidelines recommend limiting OCS use and now recommend against using OCS chronically because of its known side effects and long-term complications in patients with asthma, including obesity, diabetes mellitus, and metabolic disorders.”

With close to 1 in 13 US patients reporting an asthma diagnosis, it is one of the most significantly prominent conditions impacting communities today.² Although trends in US asthma prevalence have stagnated since 2010, there was a significant increase between 2001 and 2010. With lifetime asthma estimates now reaching close to 44.2 million American patients, researchers are looking for better ways to address the condition as common methods exhibit minimal patient improvements.³

OCS have been a prominent treatment option for patients with asthma because of their anti-inflammatory effects. However, according to the Mayo Clinic, it’s important to weigh the risks and benefits of OCS use because of commonly reported adverse events, including fluid buildup, high blood pressure, upset stomach, weight gain, and issues surrounding mood swings, memory, behavior, and other psychological functions.⁴

READ MORE: Do Albuterol Inhalers Increase the Risk of Cardiovascular Disease?

On the economic side of OCS use among patients with asthma, out-of-pocket costs can certainly add up. OCS are not specifically grouped as high-cost drugs, as reports say some formulations of this drug class can cost as low as $10.51 for 10 tablets.⁵ However, with the increased use of these drugs comes a rising potential for the aforementioned adverse effects, which can then lead to exorbitant health care costs.

“With rapidly increasing rates of obesity, diabetes mellitus, and metabolic disorder in the US, the increasing impact of OCS overuse on population health (generally considered as ≥60% of patients with severe asthma being prescribed maintenance OCS), and its potential to cause comorbid disease, is poorly appreciated, but should be further explored,” continued the study authors.¹ “In this study, a large claims database featuring 826,065 patients was used to detail and describe the treatment patterns of OCS in asthma, including the disease and economic burden being caused as a result.”

What Are the Real-World Burdens of OCS Use for Asthma?

Within the IQVIA PharMetrics Plus database, researchers conducted a retrospective study of claims spanning from January 2015 to December 2019. Participants of the study included adult patients with asthma who have used OCS and were defined as chronic users. They were then grouped into 3 categories: continuous users (≥10 mg/day taken over 90 days), cumulative users (≥500 mg taken over 12 months), or burst users (≥2 bursts taken over 12 months).¹

After data collection, a total of 86,708 patients met inclusion criteria, with 1358 in the OCS continuous group, 43,215 in the cumulative group, and 46,774 patients in the burst group. Since the number of patients meeting inclusion criteria was fewer than the total number of participants in each group, researchers uncovered overlap where participants belonged to 1 or more groups.

“Before OCS use, continuous users were older and had higher comorbidity burden than cumulative and burst users,” they wrote. “After OCS use, continuous users had higher OCS exposure, higher OCS comorbidity rates, higher asthma-related health care resource utilization, and higher asthma-related health care costs than cumulative and burst users.”

Further highlighting the increased clinical risks among OCS users, those in higher exposure groups experienced increases in diabetes, obesity, cardiovascular events, psychiatric disorders, osteoporosis, and digestive disorders. Regarding total medical costs following chronic OCS use, they ranged from $3997 to $9482 per patient per year. For pharmacy costs, participants’ financial burden ranged from $1167 to $2034.¹

“Chronic use of OCS has been shown to have a dose-response relationship with the risk of developing related complications and comorbid diseases, including obesity, diabetes, heart disease, osteoporosis, and psychiatric illness,” concluded authors of the study.¹ “The current use and overuse of chronic OCS, and underuse of controller therapies, remains a challenge to the current US medical systems with potential consequences on long-term health, productivity, life expectancy, and health care costs.”

READ MORE: Severe COVID-19 Increases Stroke Risk for Patients With Asthma

REFERENCES

1. Modena B, Bogart M, Averell C, et al. Burden of chronic oral corticosteroids among adults with asthma in the US. J Allergy Clin Immunol Glob. Published online January 10, 2026:100641. https://doi.org/10.1016/j.jacig.2026.100641

2. What is asthma? National Heart, Lung, and Blood Institute. April 17, 2024. Accessed January 30, 2026. https://www.nhlbi.nih.gov/health/asthma

3. Asthma trends and burden. American Lung Association. July 15, 2024. Accessed January 30, 2026. https://www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/trends-and-burden

4. Prednisone and other corticosteroids: Balance the risks and benefits. Mayo Clinic. December 9, 2022. Accessed January 30, 2026. https://www.mayoclinic.org/tests-procedures/cortisone-shots/in-depth/steroids/art-20045692

5. Morris MS. Prednisone cost: How much is prednisone without insurance? GoodRx. June 21, 2024. Accessed January 30, 2026. https://www.goodrx.com/prednisone/how-much-is-prednisone-without-insurance