Innovative analysis predicts steroid-related health risks for people with asthma
- Shilpa Suresh
- Apr 8
- 2 min read
Singapore, [8 April 2025] – Groundbreaking research by the Observational and Pragmatic Research Institute (OPRI) has developed innovative models to predict individual patients’ risks of developing common health problems related to oral corticosteroid (OCS) treatment for asthma.
The study applied advanced statistical techniques to analyse longitudinal electronic medical records (EMR) from nearly 250,000 patients in the Optimum Patient Care Research Database (OPCRD). The resulting models incorporated OCS prescriptions and onset of medical conditions, together with evidence on risk factors for common morbidities associated with OCS exposure, to predict the future risk of OCS adverse outcomes based on a patient’s unique risk factors and projected OCS use (Figure 1).
Mean annual OCS prescriptions were categorized as none, low (<2/year), or high (≥2/year). Cox proportional hazard models for a hypothetical patient were input to survival analyses where only OCS prescriptions varied: unchanged (none to none, low to low, high to high); 1 category increase (none to low, low to high); 1 category decrease (high to low, low to none) – with all other variables held constant. Survival estimates were plotted to give the predicted incidence curve.
In these models, the risks of type 2 diabetes, hypertension, pneumonia, osteoporosis and 12 other OCS-related adverse outcomes significantly increased with projected categoric OCS use. For example, hazard ratios for a one-category increment were 1.55 for type 2 diabetes, 1.56 for post-menopausal osteoporosis, 1.05 for hypertension, and 1.67 for pneumonia (all p < 0.001).
“These real-world, data-driven insights empower clinicians to make informed decisions about reducing OCS use where possible, tailoring treatment to mitigate health risks for individual patients,” said lead investigator Dr Brooklyn Stanley.
This first tool to assess individualised risk for multiple steroid-related conditions, offers clinicians a new decision-making aid that can be integrated with routine consultations to proactively identify patients at increased risk for future OCS-related morbidities, so that timely interventions can be initiated and OCS exposure minimized, consistent with current best practice in asthma management.
“This study clearly demonstrates the utility of EMR data for predictive analysis,” said OPRI Director Professor David Price, “these new algorithms can be used to develop a web-based risk calculator that is compatible with EMRs and quality improvement tools internationally.”
Importantly, these real-world primary care EMR data showed that, once started, OCS prescription usually continued long-term; this highlights the unmet need to minimise OCS use, for example, by initiating steroid-sparing or biologic therapies earlier in the asthma treatment pathway. Although barriers such as cost and accessibility remain, this study underscores the potential benefit of shifting from OCS overuse toward precision asthma medicines.
"This research is another important step toward precision medicine in asthma care and underscores the importance of adopting steroid-sparing treatment options,” said Soram Patel, AstraZeneca Senior Global Medical Affairs Leader. “By helping clinicians assess individual patient risks, we can significantly reduce avoidable long-term health risks associated with over-reliance on OCS."
Learn More
Read the full publication, ‘Predicting Risk of Morbidities Associated with Oral Corticosteroid Prescription for Asthma’, in the March 2025 issue of Pragmatic and Observational Research.
This research project was partly funded by AstraZeneca and the Observational and Pragmatic Research Institute.
About OPRI
The Observational and Pragmatic Research Institute (OPRI) is an internationally recognized independent research organization dedicated to providing real-world evidence that supports best practices in chronic disease management in primary care. Learn more at https://www.opri.org.uk/. For media inquiries and additional information, please contact https://www.opri.org.uk/contact.
