Oral corticosteroids in pre‐school wheeze

Aspergillus spp. are spore forming molds; a subset of which are clinically relevant to humans and can cause significant morbidity and mortality. A. fumigatus causes chronic infection in patients with chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). In patients with CF, A. fumigatus infection can lead to allergic disease, such as allergic bronchopulmonary aspergillosis (ABPA) which is associated with high rates of hospitalizations for acute exacerbations and lower lung function. ABPA results from TH2 immune response to Aspergillus antigens produced during hyphal growth, marked by high levels of IgE and eosinophil activation. Clinically, patients with ABPA experience difficulty breathing; exacerbations of disease and are at high risk for bronchiectasis and lung fibrosis. Oral corticosteroids are used to manage aspects of the inflammatory response and antifungal agents are used to reduce fungal burden and lower the exposure to fungal antigens. As the appreciation for the severity of fungal infections has grown, new therapies have emerged that aim to improve treatment and outcomes for patients with CF.

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Considerations for and Mechanisms of Adjunct Therapy in COPD

Journal of Clinical Medicine ◽

10.3390/jcm10061225 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1225

Author(s):

Rachana Mandru ◽

Christine Y. Zhou ◽

Rachel Pauley ◽

Robert M. Burkes

Keyword(s):

Vitamin D ◽

Adverse Events ◽

Hypertonic Saline ◽

Clinical Data ◽

Therapeutic Approach ◽

Vitamin D Supplementation ◽

Review Article ◽

Macrolide Antibiotics ◽

Oral Corticosteroids ◽

Expert Recommendations

Inhaled bronchodilators and corticosteroids, when indicated, form the backbone of COPD therapy. However, over the last decade there has been an emergence of adjunct therapies in oral or inhaled form that are now part of the therapeutic approach to COPD. While these therapies have shown to be beneficial when used in the appropriate instances, there are particular considerations that need to be minded when using these therapies. This review article discussed the mechanism of roflumilast, macrolide antibiotics, other chronic antibiotic regimens, vitamin D supplementation, oral corticosteroids, n-acetylcysteine, and nebulized hypertonic saline, the clinical data behind each of these therapies, adverse events associated with therapy, and the expert recommendations for their utilization. Our goal is to provide a brief but informative and clinically useful review of commonly encountered therapies used in advanced COPD.

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Risk of COVID-19 Infection Among Chronic Rhinosinusitis Patients Receiving Oral Corticosteroids

Otolaryngology ◽

10.1177/01945998211006931 ◽

2021 ◽

pp. 019459982110069

Author(s):

Lauren E. Miller ◽

Neil Bhattacharyya

Keyword(s):

Conservative Treatment ◽

Chronic Rhinosinusitis ◽

Treatment Regimen ◽

Medical Management ◽

Steroid Use ◽

Positive Diagnosis ◽

Increased Risk ◽

Significant Difference ◽

Oral Corticosteroids

Chronic rhinosinusitis (CRS) management frequently comprises conservative treatment, including a combination of topical and oral corticosteroids (OCSs). However, in the midst of the coronavirus disease 2019 (COVID-19) pandemic, providers may have been reluctant to prescribe OCSs out of possible concern for an increased risk of contracting COVID-19 or developing more severe COVID-19 symptoms. This study thus sought to explore the association between the use of OCSs and the development of COVID-19 in patients with CRS. We found no statistically significant difference in the rates of patients with a positive diagnosis of COVID-19 who underwent an OCS treatment regimen compared to those who did not, both within 28 days ( P = .389) and 14 days ( P = .676) prior to the COVID-19 test. Given OCSs are often a major component of medical management of CRS, this study proves helpful in counseling patients on risks of steroid use in CRS treatment during the COVID-19 pandemic.

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Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

Respiratory Research ◽

10.1186/s12931-021-01615-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Helgo Magnussen ◽

◽

Sarah Lucas ◽

Therese Lapperre ◽

Jennifer K. Quint ◽

...

Keyword(s):

Primary Care ◽

Triple Therapy ◽

Comparative Effectiveness ◽

Inhaled Corticosteroids ◽

Blood Eosinophil ◽

Research Database ◽

Effectiveness Study ◽

Increased Risk ◽

Comparative Effectiveness Study ◽

Oral Corticosteroids

Abstract Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. Results A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94–1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10–1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03–2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. Conclusions In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS30851).

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The Diagnostic Conundrum of Retinitis and a Pigmented Scar

Case Reports in Ophthalmology ◽

10.1159/000513108 ◽

2021 ◽

pp. 164-168

Author(s):

Nikhila S. Khandwala ◽

Jason M.L. Miller ◽

Robert A. Hyde ◽

Christopher D. Conrady ◽

Rajesh C. Rao ◽

...

Keyword(s):

Silicone Oil ◽

Antiviral Agents ◽

Retinal Vasculitis ◽

Dual Therapy ◽

Diagnostic Dilemma ◽

Therapy Regimen ◽

Oral Corticosteroids ◽

Simplex Virus ◽

Herpes Simplex Virus 2 ◽

Chorioretinal Scar

We report a finding of a pigmented chorioretinal scar with acute retinal necrosis (ARN) caused by herpes simplex virus 2 (HSV-2) infection rather than toxoplasma, creating an initial diagnostic dilemma. A 53-year-old functionally monocular male presented with painless floaters and blurry vision in his seeing eye over a period of 4 days. An exam demonstrated anterior chamber (AC) reaction, vitritis, multifocal patches of whitening, and an occlusive retinal vasculitis. A superior pigmented chorioretinal scar with overlying contracted vitreous was noted in the periphery with no adjacent retinal whitening. The patient was treated for both ARN and toxoplasma chorioretinitis until PCR study of the vitreous and AC returned positive for HSV-2 and negative for toxoplasmosis. Management consisted of a dual therapy regimen of both oral and intravitreal antiviral agents as well as oral corticosteroids. The patient’s clinical course was complicated by rhegmatogenous retinal detachment within 2 weeks after symptom onset, requiring pars plana vitrectomy with silicone oil and intraoperative intraocular incubation with foscarnet. We review emerging evidence for pigmented chorioretinal scars in ARN specifically caused by HSV-2, as well as diagnostic and treatment dilemmas in the management of ARN and ARN detachments.

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An unusual case of chronic abdominal pain: an association between Celiac disease and Crohn’s disease

Oxford Medical Case Reports ◽

10.1093/omcr/omab008 ◽

2021 ◽

Vol 2021 (4) ◽

Author(s):

Leen Jamel Doya ◽

Maria Naamah ◽

Noura Karkamaz ◽

Narmin Hajo ◽

Fareeda Wasfy Bijow ◽

...

Keyword(s):

Crohn’S Disease ◽

Abdominal Pain ◽

Celiac Disease ◽

Crohn's Disease ◽

Histological Study ◽

Gastrointestinal Diseases ◽

Bowel Diseases ◽

Oral Corticosteroids ◽

History Of ◽

High Caloric Diet

ABSTRACT Inflammatory bowel diseases (IBD) and Celiac disease (CeD) are immune-mediated gastrointestinal diseases with incompletely understood etiology. Both diseases show a multifactorial origin with a complex interplay between genetic, environmental factors, and some components of the commensal microbiota. The coexistence of celiac disease with Crohn’s disease is rarely reported in the literature. Here, we report a case of a 13-year-old Syrian male who presented with a history of abdominal pain, anorexia and pallor. CeD and Crohn’s disease was documented on gastrointestinal endoscopy and histological study. The patient was treated with a gluten-free, low fiber, high caloric diet, and a course of oral corticosteroids with an improvement in growth rate and abdominal pain.

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