Optimized corticosteroid therapy for respiratory disorders and role of stewardship: a narrative review

Abstract

Corticosteroids are considered the cornerstone in the treatment of respiratory diseases, especially asthma, chronic obstructive pulmonary disease (COPD) and other inflammatory airway diseases. Corticosteroids have established themselves as drugs of choice in modern respiratory practice due to their well-documented role in suppressing airway inflammation and improving pulmonary function. It’s obvious that inappropriate or prolong use of corticosteroids leads to significant adverse events, including osteoporosis, metabolic dysfunction, adrenal suppression, and infection risk. These challenges require an urgent need for optimized, evidence-based practices that balance efficacy with safety. Corticosteroid stewardship programs have emerged as a structured framework to tackle inappropriate prescribing, with the aim of fostering responsible, patient-centered use. The multidisciplinary collaboration, audit and feedback systems, digital prescribing dashboards, biomarker-guided strategies all make up part of the various elements included in the corticosteroid stewardship initiatives to ensure that such therapy is used in a rational and consistent manner. Advances in precision medicine have also extended to include the use of blood eosinophil counts and molecular biomarkers that clinicians can exploit to provide personalized corticosteroid therapy, thereby increasing therapeutic benefit while minimizing unnecessary exposure. The article provides a traditional review of the current evidence, emerging practice, and implementation models underlying the optimization of corticosteroid therapy in respiratory medicine. Also outlines how such stewardship programs can improve prescribing behaviors, mitigate adverse outcomes, and embed quality improvement processes across healthcare systems. Innovations in the integration of digital health, clinician education, and patient engagement in reshaping corticosteroid usage in both hospital and community settings are discussed.