The prevalence and impact of over-the-counter (OTC) systemic corticosteroid availability: Global insights from primary care

Background: The availability of systemic corticosteroids (SCS) without a prescription varies worldwide, affecting their use in the management of asthma and COPD. Objective: To assess the perception about the prevalence of over-the-counter (OTC) availability of SCS and its impact on their use in the management of asthma and COPD. Methods: This observational study used data from a global survey of primary care prescribers and community pharmacists in 41 countries. The questionnaire covered the OTC availability of oral and injectable corticosteroids and perceptions of self-medication practices. Results: Approximately 40.6% of participants perceived that oral or injectable corticosteroids for asthma or COPD were commonly dispensed without a prescription. Around 50.9% perceived that over-the-counter self-management with oral steroids and 30.1% with injectable steroids was common in adults and 33.9% and 17.4% respectively in children. Around 30% perceived that it was common for doctors to simply repeat previous prescriptions of oral steroids for the long-term management of asthma and COPD. There were significant regional differences in OTC availability according to professionals' perceptions and knowledge. In countries such as North America and the United Kingdom, where corticosteroids are available only on prescription, OTC availability is almost non-existent, in contrast to regions such as Africa and India where OTC access is widespread. Self-medication was reported to be common in regions with high OTC availability, which can lead to overuse and potential harm. Conclusions: The findings highlight the need for stronger rules and public health actions to limit the use of OTC corticosteroids. Actions recommended include stricter prescription rules, public awareness raising and healthcare provider education. Many healthcare professionals lacked knowledge about the need for a prescription, contributing to easy access to OTC medicines. Implications: Addressing OTC availability can reduce inappropriate corticosteroid use and improve global asthma and COPD management practices.