The Risk-Benefit Balance of Oral Corticosteroid Treatment for Asthma Attacks: A Discrete Choice Experiment of Patients and Healthcare Professionals in the UK and New Zealand

Imran Howell; Jonathan Noble; Aleksandra Howell; Caitlin Morgan; Jennifer Logan; Sarah Miller; Rekha Chaudhuri; Richard E K Russell; Mona Bafadhel; Richard Beasley; Ian D Pavord; John Buckell

doi:10.1111/resp.70077

The Risk-Benefit Balance of Oral Corticosteroid Treatment for Asthma Attacks: A Discrete Choice Experiment of Patients and Healthcare Professionals in the UK and New Zealand

Respirology. 2025 Jun 30. doi: 10.1111/resp.70077. Online ahead of print.

Authors

Affiliations

¹ Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
² Medical Research Institute of New Zealand, Wellington, New Zealand.
³ North Bristol NHS Trust, Bristol, UK.
⁴ Gartnaval General Hospital, Glasgow, UK.
⁵ Patient and Public Representative, Oxford, UK.
⁶ King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK.
⁷ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

PMID: 40589124
DOI: 10.1111/resp.70077

Abstract

Background and objective: Oral corticosteroids (OCS) are the guideline recommended treatment for all asthma attacks, but benefits must be considered alongside the potential for cumulative side-effects. There is interest in trialling biomarker-directed management of attacks to rationalise OCS treatment in those with least benefit. Understanding stakeholder perspectives on the risks and benefits associated with OCS treatment can inform trial design and shared decision-making discussions in clinical practice. The aim was to examine patients' and healthcare professionals' preferences for the risks and benefits associated with OCS treatment for asthma attacks.

Methods: Discrete choice experiment (DCE) by patients with asthma and HCPs in the UK and New Zealand. Preferences were analysed using logit models.

Results: Eight hundred and twenty-four patients and 171 HCPs completed the DCE. Avoiding the risks of permanent side effects had the greatest impact on treatment preference by patients and HCPs. Avoidance of side effects was weighted higher by patients than HCPs. Patients with uncontrolled asthma were more prepared to trade risk for benefit. Symptom recovery was the most valued clinical benefit to patients and HCPs. Patients preferred 'improving lung function' over 'avoiding additional GP treatment or hospitalisation', whereas HCPs preferred avoidance of further healthcare utilisation. Based on their responses we estimated the minimum clinically important difference for the treatment failure outcome at 20%.

Conclusion: Patients and HCPs will trade-off treatment benefits to avoid the side-effects associated with OCS. The risk-benefit balance of OCS should feature in shared decision-making discussions with patients experiencing outpatient asthma attacks. The findings support developing trials to personalise acute asthma treatment.

Keywords: asthma; asthma attacks; asthma exacerbations; corticosteroids; glucocorticoids; patient preferences.

Abstract

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