Question 6. Can oral steroids be used as alternative controller to the combination of inhaled corticosteroids and long-acting beta-2-agonist in persistent asthma?

From Chapter 6 of the Philippine Consensus Report on Asthma 2004 by the Philippine College of Chest Physicians.
This guideline starts below.

Can oral steroids be used as alternative controller to the combination of inhaled corticosteroids and long-acting beta-2-agonist in persistent asthma?

Answer

Although prednisolone 7.5 to 12 mg/day is as efficacious as inhaled steroid (800-2000 mcg/day), no study has been made on how oral steroids compare to the ICS plus LABA combination in controlling persistent asthma.

Summary of Evidence

Daily doses of prednisolone 7.5-10 mg/day are equivalent to moderate to high doses of inhaled corticosteroids. On the other hand, alternate-day doses of oral steroids and doses of less than 5 mg/day appear to be less effective than low to moderate doses of inhaled steroids. No published information about the long-term side effects of oral steroids in asthma is available. This, if there is no alternative to oral steroids, the lowest effective dose (which appears to be 7.5 mg/day) should be given.

Research Recommendation

A well-designed study should be conducted to determine how oral steroids alone compare with combined ICS with LABA in controlling the symptoms and improving the lung function of patients with persistent asthma.