Steroid-sparing strategies in respiratory diseases: efficacy and safety of current therapeutic options.

Glucocorticoids (GCs) are a fundamental component in the management of numerous respiratory diseases because of their anti-inflammatory and immunosuppressive effects. Growing recognition of the cumulative toxicity associated with systemic glucocorticoid (SGC) therapy has intensified interest in therapeutic strategies aimed at reducing steroid exposure. The wider availability of targeted therapies has created new opportunities to reduce SGC exposure while maintaining disease control. This review summarises the current evidence for the efficacy and safety of steroid-sparing therapies in selected respiratory diseases, including ANCA-associated vasculitis, allergic bronchopulmonary aspergillosis, pulmonary sarcoidosis, and asthma. Available steroid-sparing therapies differ in efficacy, strength of supporting evidence, and safety profiles. However, broader implementation of several agents remains limited by restricted indications, insufficient long-term safety data, and high treatment costs. The benefits of reducing SGC exposure should be interpreted in the context of the safety profiles of alternative therapies, which may themselves be associated with substantial toxicity. Consequently, steroid-sparing strategies should encompass more than simple dose reduction and be part of personalised treatment plans aimed at maintaining long-term disease control while minimising overall treatment-related toxicity. Although targeted therapies continue to advance, their ability to fully replace the broad therapeutic effects of GCs remains limited.