Introduction

The Leeds Asthma Service acknowledges the consequences of long-term oral corticosteroid (OCS) use and that adrenal insufficiency is under recognised. They developed a steroid weaning service for patients to facilitate the reduction in continuous OCS use and ensure that adrenal insufficiency is not missed.

Aims and objectives

This service evaluation reviewed whether patients? OCS were successfully weaned and if adrenal insufficiency was identified and managed appropriately.

Method

Digital records of patients recruited to the service between March 2020 and September 2022 were reviewed. The pre- and post-intervention OCS dose, cases of adrenal insufficiency and number of interactions with the nurses were reviewed.

Results

40 asthma patients were identified; 29 female, 11 male. Median age was 60 years (29-86). 25 (63%) patients were on biologics, 15 (37%) were not.  28 (70%) patients were weaned to 5mg and 18 (45%) to 0mg. There was increased likelihood of steroid wean when on Biologics. Weaning time varied from <1 week to >1 year. Reasons for being unable to wean included patient tolerance and exacerbations.   Adrenal insufficiency was identified in 12 (30%) patients and they were referred to endocrinology for further management.  The median number of nursing interventions was 8 (3-27). 20 (50%) of patients did not exacerbate during the wean. 8 (20%) patients had documented delays due to the covid-19 pandemic.

Conclusion

The service successfully managed to wean the vast majority of patients? OCS. While this sometimes requires intensive nursing input, it remains the much preferred option than the long-term health risks that OCS present.