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Peer-reviewedCC BY-NC-ND 4.0NPJ Primary Care Respiratory Medicine

Global perceptions and practices on systemic corticosteroid use for asthma and COPD in primary care: results from a multinational survey on prescribers and community pharmacists

  • Juliana Franceschini1,2
  • Siân Williams3
  • Neil Fitch3
  • Pedro Fonte4
  • Jaime Correia-de-Sousa5
  • Alan Kaplan6
  • Job FM van Boven7
  • Sundeep Salvi8
  • Ee Ming Khoo9
9 affiliations
  1. 1ProAR Foundation, Salvador, Brazil
  2. 2IPCRG Latam & Respiratory Study and Research Group in Primary Health Care (GEPRAPS), Santo André, Brazil
  3. 3International Primary Care Respiratory Group (IPCRG), Larbert, Scotland UK
  4. 4Family Health Unit of Minho, Health Centre Group of Braga, Braga, Portugal
  5. 5ICVS/3B’s Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
  6. 6Family Physician Airways Group of Canada, Stouffville, Canada
  7. 7Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  8. 8Pulmocare Research and Education (PURE) Foundation, Pune, India
  9. 9Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Abstract

Background: Systemic corticosteroids (SCS) are widely used in asthma and chronic obstructive pulmonary disease (COPD) management, despite proven evidence of significant adverse effects associated with their misuse/overuse. This study aimed to assess global perceptions and practices regarding SCS prescribing and dispensing for asthma and COPD among healthcare professionals responsible for managing these conditions in community and primary care settings. Methods: A cross-sectional survey was conducted among 376 participants (314 prescribers, 62 community pharmacists) across 41 countries. The self-administered questionnaire captured SCS prescribing behaviours, perceptions of overuse, and accessibility, including over-the-counter (OTC) availability. Results: Data from 376 respondents across 41 countries were analysed. Most prescribers reported access to asthma (83.7%) and COPD (80.8%) guidelines. Guideline availability was lower among community pharmacists (60.7% for asthma and 45.9% for COPD) and in low- and middle-income countries compared with high-income countries (asthma: 74.5 vs 84.1%; COPD: 62.1 vs 83.6%). Systemic corticosteroids (SCS) were frequently used for acute exacerbations, with notable long-term use in both asthma and COPD. Perceived SCS overuse was common (56.8% among community pharmacists and 60.3% among prescribers), largely attributed to limited access to inhaled or biologic therapies and prescriber knowledge gaps. Provision of SCS action packs and repeat SCS prescribing without consultation were reported in several countries. Substantial variation in regulatory environments was observed, with nearly half the respondents (48.4%) reporting oral SCS availability as OTC and frequent self-medication in adults. Conclusion: These findings, based on self-reported perceptions, emphasise the ongoing discrepancy between guideline recommendations and reported/perceived practices which may contribute to avoidable patient safety risks, underscoring the importance and need for enhanced stewardship, improved access to inhaled steroid therapies, and the adoption of strategies that promote the appropriate use of SCS, such as the IPCRG Right Care approach.

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Cite

BibTeXRIS
BibTeX
@article{franceschini2026global,
  title = {{Global perceptions and practices on systemic corticosteroid use for asthma and COPD in primary care: results from a multinational survey on prescribers and community pharmacists}},
  author = {Juliana Franceschini and Siân Williams and Neil Fitch and Pedro Fonte and Jaime Correia-de-Sousa and Alan Kaplan and Job FM van Boven and Sundeep Salvi and Ee Ming Khoo},
  journal = {NPJ Primary Care Respiratory Medicine},
  year = {2026},
  month = aug,
  doi = {10.1038/s41533-026-00549-8},
  url = {https://doi.org/10.1038/s41533-026-00549-8},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Global perceptions and practices on systemic corticosteroid use for asthma and COPD in primary care: results from a multinational survey on prescribers and community pharmacists
AU  - Juliana Franceschini
AU  - Siân Williams
AU  - Neil Fitch
AU  - Pedro Fonte
AU  - Jaime Correia-de-Sousa
AU  - Alan Kaplan
AU  - Job FM van Boven
AU  - Sundeep Salvi
AU  - Ee Ming Khoo
PY  - 2026
DA  - 2026/08/20
JO  - NPJ Primary Care Respiratory Medicine
DO  - 10.1038/s41533-026-00549-8
UR  - https://doi.org/10.1038/s41533-026-00549-8
AB  - Background: Systemic corticosteroids (SCS) are widely used in asthma and chronic obstructive pulmonary disease (COPD) management, despite proven evidence of significant adverse effects associated with their misuse/overuse. This study aimed to assess global perceptions and practices regarding SCS prescribing and dispensing for asthma and COPD among healthcare professionals responsible for managing these conditions in community and primary care settings. Methods: A cross-sectional survey was conducted among 376 participants (314 prescribers, 62 community pharmacists) across 41 countries. The self-administered questionnaire captured SCS prescribing behaviours, perceptions of overuse, and accessibility, including over-the-counter (OTC) availability. Results: Data from 376 respondents across 41 countries were analysed. Most prescribers reported access to asthma (83.7%) and COPD (80.8%) guidelines. Guideline availability was lower among community pharmacists (60.7% for asthma and 45.9% for COPD) and in low- and middle-income countries compared with high-income countries (asthma: 74.5 vs 84.1%; COPD: 62.1 vs 83.6%). Systemic corticosteroids (SCS) were frequently used for acute exacerbations, with notable long-term use in both asthma and COPD. Perceived SCS overuse was common (56.8% among community pharmacists and 60.3% among prescribers), largely attributed to limited access to inhaled or biologic therapies and prescriber knowledge gaps. Provision of SCS action packs and repeat SCS prescribing without consultation were reported in several countries. Substantial variation in regulatory environments was observed, with nearly half the respondents (48.4%) reporting oral SCS availability as OTC and frequent self-medication in adults. Conclusion: These findings, based on self-reported perceptions, emphasise the ongoing discrepancy between guideline recommendations and reported/perceived practices which may contribute to avoidable patient safety risks, underscoring the importance and need for enhanced stewardship, improved access to inhaled steroid therapies, and the adoption of strategies that promote the appropriate use of SCS, such as the IPCRG Right Care approach.
SN  - 2055-1010
ER  -