Despite prolonged administration of high inhaled corticosteroids (ICS) dosages and frequent systemic corticosteroids, severe asthmatics remain clinically and/or functionally uncontrolled. These individuals frequently have rhinitis or chronic rhinosinusitis, which necessitates the administration of intranasal corticosteroids on a regular basis. As a result, severe asthmatics are subjected to an overdose of corticosteroids, which is usually accompanied with significant and costly side effects. This clinical issue is outlined below, as are the techniques for overcoming it. A range of therapeutic options can help to reduce corticoides loads in asthmatics, from anti-IgE, anti-IL5 and anti-IL4-alpha immunosuppressants, new bio-drug products (mostly anti-IGE and anti-IL4-receptor alpha), to immunosuppressants, such as methotrexate or Cyclosporine (for patients with anti-inflammatory drugs exacerbated respiratory disease).

The evidence of even serious corticosteroid-related adverse events linked to consistent health-care costs should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce corticosteroid need in asthmatics; the most promising option appears to be the addition of biologic agents.