When it manifests itself with severe symptoms, asthma is a disease mainly treated with corticosteroid drugs. In Italy, about 124,000 asthmatics are regularly exposed to this treatment and its non-negligible side effects, which, in turn, require further treatment. The new frontier is represented by therapies with biological drugs, which can reduce the use of cortisone. This type of treatment allows in the long run a saving in the cost of treating this disease but especially for the side effects related to it in the case of long-term cortisone therapies. We talked about it with Prof. Giorgio Walter Canonica, Past President of SIAAIC and Head of the Center for Personalized Medicine: Asthma and Allergology of Humanitas.
6 months of treatment increase the incidence of various diseases
In all, over 4 million Italians suffer from asthma: 200,000 of them suffer from the severe form and 124,000 are treated with oral corticosteroids chronically and this exposes them to the risk of encountering various side effects. The use of corticosteroids for over 6 months for the treatment of severe asthma not only increases the risk of side effects, but also increases the costs of dealing with problems such as hypertension, osteoporosis and fractures, cataracts and glaucoma, diabetes and kidney failure.
The first Italian study carried out and published in the World Allergy Organization Journal (WAOJ), has carefully evaluated the clinical and economic impact of corticosteroids in severe asthma thanks to data from the Register of the project SANI (Severe Asthma Network Italy). The study, promoted by SIAAIC, the Italian Society of Asthma, Allergy and Clinical Immunology, in collaboration with the Italian Society of Pneumology (SIP), the GINA guidelines (Global Initiative on Asthma) and the pharmaco-economists of the University of Pavia, assessed these drugs as having a high economic impact, as well as full of side effects.
The need to perform therapies correctly
Only 13.8 percent of the patients with severe asthma properly perform the inhalation therapies prescribed by the doctor and also resort to new therapies with biological drugs that can reduce the use of cortisone, which therefore allow in the long run a savings in the cost of treatment but especially “most Italians with asthma achieve a good control of the disease using low doses of cortisone inhalers, but a 3.5-10% requires higher dosages or fails to have a good control of symptoms anyway,” explains Dr. Canonica -. The results obtained by evaluating the cost of each adverse event related to the rate of probability that this occurs, clearly show an increase in expenditure as the use of cortisone increases: for a non-asthmatic subject we speak of about 1000 euros per year, in those suffering from severe asthma the disbursement doubles, reaching about 2000 euros per patient per year.
Osteoporosis and kidney failure as side risks
Osteoporosis affects 16% of severe asthmatics exposed to cortisone, compared to 3% of the general population. Then there are the digestive disorders, which affect 65% against 24% of those who do not have severe asthma, kidney failure, which from 7% rises to 14%, diabetes, which reaches 10% against 6%, obesity, which rises to 42% against 23% of the general population.
Restricting the use of cortisone and preferring biological drugs could therefore avoid even serious problems for patients.