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Limited published studies suggest OCS usage varies across countries and recent registry data indicate that at least 25\u201360% of patients with severe asthma in developed countries may at some stage be prescribed OCS. Recent evidence indicate that many patients do not receive optimal therapy for asthma and are often prescribed maintenance OCS or repeated steroid bursts to treat exacerbations. Given the recent progress in adult severe asthma and new treatment options, judicious appraisal of steroid use is merited. A number of strategies and add\u2010on therapies are now available to treat severe asthma. These include increasing specialist referral for multidisciplinary assessments and implementing OCS\u2010sparing interventions, such as improving guideline adherence and add\u2010on tiotropium and macrolides. Biologics have recently become available for severe asthma; these agents reduce asthma exacerbations and lower OCS exposure. Further research, collaboration and consensus are necessary to develop a structured stewardship approach including realistic OCS\u2010weaning programmes for patients with severe asthma on regular OCS; education and public health campaigns to improve timely access to specialized severe asthma services for treatment optimization; and implementing targeted strategies to identify patients who warrant OCS use using objective biomarker\u2010based strategies.<\/jats:p>","DOI":"10.1111\/resp.13730","type":"journal-article","created":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T05:46:00Z","timestamp":1573537560000},"page":"161-172","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Rational oral corticosteroid use in adult severe asthma: A narrative review"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7601-9678","authenticated-orcid":false,"given":"Li Ping","family":"Chung","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Fiona Stanley Hospital  Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0017-3433","authenticated-orcid":false,"given":"John W.","family":"Upham","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Princess Alexandra Hospital and University of Queensland  Brisbane QLD Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9596-574X","authenticated-orcid":false,"given":"Philip G.","family":"Bardin","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine Monash Medical Centre, Monash University  Melbourne VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7498-0000","authenticated-orcid":false,"given":"Mark","family":"Hew","sequence":"additional","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology Alfred Hospital  Melbourne VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,12]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"803","article-title":"Controlled trial of effects of cortisone acetate in status asthmaticus; report to the Medical Research Council by the subcommittee on clinical trials in asthma","volume":"271","year":"1956","journal-title":"Lancet"},{"key":"e_1_2_10_3_1","first-page":"CD000195","article-title":"Corticosteroids for preventing relapse following acute exacerbations of asthma","author":"Rowe BH","year":"2001","journal-title":"Cochrane Database Syst. 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