scholarly journals Effects of high doses of inhaled corticosteroids on adrenal function in children with severe persistent asthma.

Thorax ◽  
1993 ◽  
Vol 48 (6) ◽  
pp. 599-602 ◽  
Author(s):  
T K Ninan ◽  
I W Reid ◽  
P E Carter ◽  
P J Smail ◽  
G Russell
Keyword(s):  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
Adrenal Function ◽  
Severe Persistent Asthma ◽  
High Doses

CLINICAL AND SPIROGRAPHIC FEATURES OF BRONCHIAL ASTHMA IN SCHOOLCHILDREN DEPENDING ON THE DIFFERENT REGIMENS OF BASIC ANTI-INFLAMMATORY THERAPY

2020 ◽  
Vol 73 (1) ◽  
Author(s):  
Olena Koloskova ◽  
Tetiana Bilous ◽  
Galyna Bilyk ◽  
Kristina Buryniuk-Glovyak ◽  
Olena Korotun ◽  
...  
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
High Specificity ◽  
Clinical Feature ◽  
Clinical Group ◽  
Comparison Groups ◽  
Anti Inflammatory ◽  
High Doses ◽  
Persistent Bronchial Asthma

The aim: To study the clinical and spirographic features persistence of the bronchial asthma in schoolchildren against the background of the alternative daily doses of inhaled corticosteroids to increase the effectiveness of anti-inflammatory therapy for this disease. Materials and methods: A complete comprehensive clinical-paraclinical examination of 65 schoolchildren with persistent asthma was conducted. According to the average daily dose of inhaled corticosteroids (ICS) the patients were divided into two clinical groups. The first (I) group consisted of 46 children who received ICS in the regimen of low-to-medium equipotent doses (253.95±9.98 μg per day), and the second (II) comparison group was formed of 19 patients who controlled the pBA using high doses of ICS (494.74±5.56 μg per day). Results: The patients of the І clinical group compared to patients of the ІІ group have a higher risk of the mild bronchial obstructive syndrome during asthma attacks. In assessing the level of control of persistent bronchial asthma using the CIA-scale, it was found that in II group cases of the controlled course of the disease were observed almost two times less than in children of the I group of comparison. In conducting spirography in children of comparison groups, it was shown that the ratio of indices of bronchospasm (FEV1/ FVC) was worse in patients receiving high doses of ICS. Conclusions: So, сharacteristic clinical feature of asthma controlled by high doses of ICS is more severe nature of bronchial obstructive syndrome during the period of exacerbation (OR=1.9-3.0). In the management of persistent bronchial asthma, the Gensler index which has high specificity (94.4%) and accuracy (92.2%) should be used for disease control verification.

scholarly journals Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project

2020 ◽  
Vol 7 (1) ◽  
pp. e000484 ◽  
Author(s):  
Bruce Kirenga ◽  
Jeremiah Chakaya ◽  
Getnet Yimer ◽  
George Nyale ◽  
Tewodros Haile ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
Asthma Severity ◽  
Adult Onset ◽  
Phenotypic Characteristics ◽  
Multivariable Logistic Regression Model ◽  
Prick Test ◽  
Asthma Morbidity ◽  
Severe Persistent Asthma ◽  
History Of

RationaleThe relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.MethodsUsing the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.ResultsA total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.DiscussionThe majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.

Successful Treatment of Previously Uncontrolled Adult Asthma with Budesonide Inhalation Suspension: Five-Year Case Histories

2007 ◽  
Vol 41 (10) ◽  
pp. 1728-1733 ◽  
Author(s):  
Sandra M Gawchik
Keyword(s):  
Asthma Control ◽  
Oral Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Case Reports ◽  
Persistent Asthma ◽  
Urgent Care ◽  
Severe Persistent Asthma ◽  
Before And After ◽  
Valuable Treatment ◽  
Poor Outcomes

Objective: To determine whether nebulized budesonide inhalation suspension (BIS) is effective in treating adults with asthma that has been uncontrolled by inhaled therapies. Case Summaries: Three adults with severe persistent asthma were switched to BIS after poor outcomes with other controller medications, including inhaled corticosteroids (ICSs). BIS dosages were initiated with 1 mg twice daily. Based on physician discretion as symptoms improved, dosages were decreased to 0.5 mg twice daily (2 pts.) or once daily (1 pt.). Patients were instructed to self-manage their asthma, increasing their dosages during periods of asthma worsening. Peak expiratory flow (PEF) was assessed before and after the initiation of BIS. The number of healthcare visits and oral corticosteroid courses recorded in patient medical records during the 3 years before and 5 years after initiation of BIS therapy were compared. In all 3 cases, BIS improved asthma control. BIS consistently increased PEF and reduced the number of urgent care visits and oral corticosteroid courses. All patients reported satisfaction with BIS therapy. Discussion: Despite proven effectiveness of ICSs for persistent asthma, some patients fail to respond optimally to treatment administered via an inhaler. These 3 case reports suggest that BIS is effective in treating adults with severe persistent asthma who fail to respond optimally to treatment with other ICS preparations. Failure to use inhalers properly, previous poor adherence in 1 case, or patient preference for the nebulizer might explain why nebulized BIS was more effective than other inhaler therapies. Conclusions: Switching adults with uncontrolled asthma to BIS therapy may be a valuable treatment option for those who are unable to achieve optimal asthma control, despite asthma education and training on inhaler technique.

Combined Budesonide/Formoterol Turbuhaler Treatment of Asthma

2002 ◽  
Vol 36 (12) ◽  
pp. 1918-1928 ◽  
Author(s):  
Tami L Remington ◽  
Andrea M Heaberlin ◽  
Bruno DiGiovine
Keyword(s):  
Combination Therapy ◽  
Product Information ◽  
Inhaled Corticosteroids ◽  
Data Extraction ◽  
Persistent Asthma ◽  
Rapid Onset ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Medline Search ◽  
Severe Persistent Asthma

OBJECTIVE: To provide product information; review and analyze the clinical literature studying combination therapy, budesonide, and formoterol in asthmatics; and to define the role for this therapy in asthma treatment. DATA SOURCES: A MEDLINE search (1990–September 2001) was conducted to identify the primary literature. Bibliographies were reviewed for further relevant citations. STUDY SELECTION/DATA EXTRACTION: All randomized, blinded, controlled studies at least 3 months in duration exploring the efficacy of the combination of budesonide and formoterol (in 1 or separate formulations) compared with other treatments were selected to be included in the review of clinical studies. DATA SYNTHESIS: The combination of budesonide and formoterol was more effective than increasing the dose of budesonide in patients with moderate or severe persistent asthma and in patients with mild asthma not previously controlled with inhaled corticosteroids. Milder corticosteroid-naïve asthmatics did not derive benefit compared with inhaled corticosteroids alone. CONCLUSIONS: Combination therapy in 1 device is a preferred treatment option in patients with moderate to severe persistent asthma and in those with milder asthma not controlled with inhaled corticosteroids. Advantages of this product include rapid onset of action, long duration of action, and a wide dosing range to assist with titration. Further research is required to evaluate this therapy in asthmatic children <5 years old and in patients with oral corticosteroid—dependent asthma. Investigations into the effect of this combination product on other disease outcomes, such as quality of life and productivity, will further define the role for this drug therapy.

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