Global perceptions and practices on systemic corticosteroid use for asthma and COPD in primary care: results from a multinational survey on prescribers and community pharmacists

Abstract Background Systemic corticosteroids (SCS) are widely used in asthma and chronic obstructive pulmonary disease (COPD) management, despite proven evidence of significant adverse effects associated with their misuse/overuse. This study aimed to assess global perceptions and practices regarding SCS prescribing and dispensing for asthma and COPD among healthcare professionals responsible for managing these conditions in community and primary care settings. Methods A cross-sectional survey was conducted among 376 participants (314 prescribers, 62 pharmacists) across 41 countries. The self-administered questionnaire captured SCS prescribing behaviours, perceptions of overuse, and accessibility, including over-the-counter (OTC) availability. Results Data from 376 respondents across 41 countries were analysed. Most prescribers reported access to asthma (83.7%) and COPD (80.8%) guidelines, though availability was lower among community pharmacists (60.7% for asthma and 45.9% for COPD) and in low- and middle-income countries (LMICs) (60.7% for asthma and 45.9% for COPD vs (60.7% for asthma and 45.9% for COPD in HIC). Systemic corticosteroids (SCS) were frequently used for acute exacerbations, with notable long-term use in both asthma and COPD. Perceived SCS overuse was common (60–67%), largely attributed to limited access to inhaled or biologic therapies and prescriber knowledge gaps. Provision of SCS action packs and repeat SCS prescribing without consultation were reported in several countries. Substantial variation in regulatory environments was observed, with nearly half the respondents (48.4%) reporting oral SCS availability as OTC and frequent self-medication in adults. Conclusion These findings, based on self-reported perceptions, emphasise the ongoing discrepancy between recommended and actual practices that compromise patient safety, underscoring the importance and need for enhanced stewardship, improved access to inhaled steroid therapies, and the adoption of strategies that promote the appropriate use of SCS, such as the IPCRG Right Care approach.