Efficacy of inhaled corticosteroids in asthma☆,☆☆,★
Section snippets
ANTIINFLAMMATORY MECHANISMS
Corticosteroids are very effective at suppressing the eosinophilic inflammation in the airways of patients with asthma. This antiinflammatory effect is through increased transcription and expression of antiinflammatory proteins, such as IL-1 receptor antagonist, IL-10, and neutral endopeptidase. More importantly, this effect is through repression of inflammatory genes, such as cytokines involved in the inflammatory response in asthma (eg, IL-4, IL-5, and chemokines involved in eosinophil
CLINICAL EFFICACY
Inhaled corticosteroids are very effective in controlling asthma symptoms in asthmatic patients of all ages with asthma of all severities (Table I).1, 5, 6
• Control symptoms • Improve quality of life • Improve lung function • Prevent exacerbations • Reduce mortality (probably) • Prevent irreversible airway changes • Alter natural history of asthma (?)
CLINICAL USE OF INHALED CORTICOSTEROIDS
Inhaled corticosteroids are now recommended as first-line therapy for all patients with persistent symptoms.1 Inhaled corticosteroids should be started in any patient who needs to use a β2 -agonist inhaler for symptom control more than once daily (or possibly 3 times weekly). It is conventional to start with a low dose of inhaled corticosteroid and to increase the dose until asthma control is achieved. However, this may take time, and a preferable approach is to start with a dose of
CORTICOSTEROID-RESISTANT ASTHMA
Although glucocorticoids are highly effective in the control of asthma and other chronic inflammatory or immune diseases, a small proportion of patients with asthma fail to respond even to high doses of oral glucocorticoids.38, 39 Resistance to the therapeutic effects of glucocorticoids is also recognized in other inflammatory and immune diseases, including rheumatoid arthritis and inflammatory bowel disease. Corticosteroid-resistant patients, although uncommon, present considerable management
FUTURE DIRECTIONS
Inhaled corticosteroids are now used as first-line therapy for the treatment of persistent asthma in adults and children in many countries because they are the most effective treatments for asthma currently available. The recent trend to start with a relatively high dose of inhaled corticosteroids to achieve more rapid control of asthma before the dose is reduced to the minimum needed to maintain control may lead to lower overall maintenance doses.6 Although many patients, particularly those
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Consensus document for severe asthma in adults. 2022 update
2022, Open Respiratory ArchivesAsthma Diagnostics, Testing and Treatment
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2021, International Journal of PharmaceuticsOverweight improves long-term survival in Japanese patients with asthma
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2020, Biochemical PharmacologyCitation Excerpt :Patients with severe forms of asthma show insensitive response towards these drugs. The precise summary of various drugs available in market along-with their associated side effects are discussed in (table 1) [86–88]. Furthermore, anti-cytokines therapies have broadened the arms of therapeutic strategies for asthma.
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From the National Heart and Lung Institute, Imperial College, London.
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Reprint requests: Peter J. Barnes, Department of Thoracic Medicine, National Heart and Lung Institute, Dovehouse St, London SW3 6LY, UK.
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0091-6749/98 $5.00 + 0 1/1/92361