Structured tapering of oral corticosteroids in patients with severe asthma at risk of secondary adrenal insufficiency: a case series

Severe asthma is a chronic condition that often requires oral corticosteroid (OCS) therapy, which, when prolonged, may lead to significant adverse effects, including secondary adrenal insufficiency. Advances in biologic therapies have allowed many patients to reduce or discontinue OCS. We describe the clinical course and outcomes of six patients with severe corticosteroid-dependent asthma who underwent a structured OCS tapering protocol under endocrinological supervision. All patients had a history of prolonged OCS use (mean duration >10 years), high-dose inhaled corticosteroids (ICS), and biologic therapy. Adrenal insufficiency was confirmed in three patients (50%), who required continued hydrocortisone replacement due to persistent hypothalamic-pituitary-adrenal (HPA) axis suppression. The other three patients successfully discontinued corticosteroids and demonstrated HPA axis recovery. Notably, no asthma exacerbations occurred during the tapering process. A structured, multidisciplinary corticosteroid tapering protocol is both feasible and safe in patients with severe asthma, particularly when guided by endocrine assessment. ICS exposure may contribute to adrenal suppression, highlighting the need for comprehensive hormonal evaluation in this population.