Biologics vs. Improved Adherence to Inhaled Corticosteroid Therapy in Asthma

Asian woman using a pressurized cartridge inhaler extended pharynx, Bronchodilator
Is biologic therapy for patients with asthma who overuse OCS prescribed in lieu of improving inhaler technique and adherence to ICS therapy?

A Dutch study found improving low rates of inhaled corticosteroid therapy adherence among patients with asthma may potentially eliminate the need for prescribing expensive biologic therapy. Findings of this study were recently published in the journal Respiration.

To estimate the proportion of patients with asthma who might receive biologics unnecessarily, researchers surveyed 5002 Dutch adults with at least 1 prescription of high-dose ICS, gathering data on patients’ annual cumulative oral corticosteroid (OCS) dose, prescription fillings, and inhaler technique.

Among the 2312 patients who returned the mailed questionnaire, 929 had asthma. A total of 29.5% of asthma patients on high-dose ICS also used high doses of OCS. Based on collected data, researchers estimated that 78.1% of these patients were likely to have poor therapy adherence or inadequate inhaler technique. Therefore, only 21.9% of the patients on high doses of OCS were considered definitive candidates for biologic therapy because optimization of inhaler therapy could reduce the need for OCS without the expensive alternative.

The study authors wrote, “Physicians should therefore not prescribe expensive biologics to patients with high OCS use until they have thoroughly verified that inhaled ICS therapy is being used in an adequate and appropriate manner.”

Disclosure: A study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Eger K, Amelink M, Hashimoto S, Hekking PP, Longo C, Bel EH. Overuse of oral corticosteroids, underuse of inhaled corticosteroids, and implications for biologic therapy in asthma. Respiration. Published online September 14, 2021. doi:10.1159/000518514