Aerosol Corticosteroids for the Treatment of Asthma

1987 ◽  
Vol 21 (10) ◽  
pp. 784-790 ◽  
Author(s):  
Cary E. Johnson
Keyword(s):  
Beclomethasone Dipropionate ◽  
Adverse Reactions ◽  
Inhaled Corticosteroids ◽  
Antiinflammatory Activity ◽  
Corticosteroid Treatment ◽  
Beta Agonist ◽  
Systemic Effects ◽  
Patient Response ◽  
Clinically Significant ◽  
The U.S

In an effort to maximize the efficacy of corticosteroid treatment in asthma and minimize the adverse reactions, steroid therapy has evolved to the inhalation route of administration with aerosol compounds having potent topical antiinflammatory activity and minimal systemic effects. Corticosteroids exhibiting these properties that are available in the U.S. include beclomethasone dipropionate, triamcinolone acetonide, and flunisolide. The success or failure of patient response to orally inhaled corticosteroids is often a function of adequate drug delivery rather than the efficacy of the drug itself. Patients who cannot use the inhaler accurately may benefit from the use of a spacer or reservoir device. The three aerosolized corticosteroids have specific pharmacologic differences; however, none of these differences has translated into a clinically significant advantage or disadvantage of one product over the others. These agents should be considered for adjunctive therapy in patients whose asthma is not adequately controlled by beta-agonist bronchodilators, theophylline, or cromolyn sodium.

scholarly journals Comparison of 12-Week Additional Effect Features of Formoterol Co-Inhalation and Tulobuterol Patch on Budesonide Inhalation in Elderly Patients With Asthma

2020 ◽  
Vol 11 ◽  
pp. 215265672098041
Author(s):  
Susumu Fukahori ◽  
Tetsuya Kawano ◽  
Yasushi Obase ◽  
Jun Iriki ◽  
Tomoko Tsuchida-Yabe ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Inhaled Corticosteroids ◽  
Drug Formulation ◽  
University Hospital ◽  
Beta Agonist ◽  
Life Questionnaire ◽  
Care Organization ◽  
Asthma Control Questionnaire ◽  
Clinical Difference ◽  
Bronchial Inflammation

Background For asthma strategy, to avoid the aggravation of bronchial inflammation and contraction, the long acting beta agonist (LABA) addition on inhaled corticosteroids (ICS) has been recommended. Objectives To know whether there is any clinical difference between the additional efficacies of Formoterol (FOR) and Tulobuterol (TUL) onto Budesonide (BUD) may be useful for the elderly patients’ asthma treatment strategy. Methods Eighteen outpatients with mild to moderate bronchial asthma with FEV1.0% < 80% treated by intermediate ICS dosages visited Respiratory Division of Nagasaki University Hospital or Isahaya General Hospital, Japan Community Health care Organization were subjected, and were randomly assigned (9 cases per group) to either the FBC group (BUD/FOR 160/4.5 µg, 2 inhalations twice daily) or BUD + TUL group (BUD 200 mcg: 2 inhalations twice daily + TUL 2 mg daily) and were compared in parallel with 2 arms for 12 weeks prospectively. Peak expiratory flow, forced expiratory volume in 1 second, impulse oscillometry (IOS), fractional exhaled nitric oxide (FeNO), Asthma Control Questionnaire, mini-Asthma Quality of Life Questionnaire (mini-AQLQ), and occurrence of adverse reactions were compared. Results The “Fres” of IOS was improved in FBC group (p = 0.03). The “emotion” domain of mini-AQLQ was improved in BUD + TUL group (p = 0.03). Conclusion By changing the drug formulation, the patch was superior in terms of satisfaction, but it was thought that the inhaled combination was superior in improving the respiratory function itself. It is necessary to pay attention to the characteristics of the patient when selecting treatment.

Hypoglycemia and Cortisol Deficiency Associated With Low-dose Corticosteroid Therapy for Asthma

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 921-924
Author(s):  
Aaron L. Carrel ◽  
Stephanie Somers ◽  
Robert F. Lemanske ◽  
David B. Allen
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Chronic Asthma ◽  
Asthma Therapy ◽  
Biochemical Alterations ◽  
Clinically Significant ◽  
Dose Corticosteroid ◽  
Oral Glucocorticoids ◽  
Cortisol Deficiency

Glucocorticoids are a cornerstone of the anti-inflammatory treatment of asthma. To minimize adverse effects of oral glucocorticoids (OGC), clinicians have used alternate-day oral or inhaled corticosteroids (IC), both generally considered safe for chronic asthma therapy in children. Although reversible growth suppression occasionally occurs, the general consensus is that, despite detectable biochemical alterations, these modes of therapy are not associated with clinically significant adrenal insufficiency.1 We report the occurrence of hypoglycemia due to cortisol deficiency during combination alternate-day oral and inhaled corticosteroids. CASE HISTORY A 3½-year-old boy with asthma was found one morning to be unarousable, limp, and blue around the lips.

scholarly journals Systemic effects of inhaled corticosteroids.

Thorax ◽  
1993 ◽  
Vol 48 (10) ◽  
pp. 955-956 ◽  
Author(s):  
J P Monson
Keyword(s):  
Inhaled Corticosteroids ◽  
Systemic Effects

The Impact Of Tiotropium On Mortality When Added To Inhaled Corticosteroids And Long-Acting Beta Agonist Therapy In COPD

2011 ◽  
Author(s):  
Philip M. Short ◽  
William J. Anderson ◽  
Peter A. Williamson ◽  
Samuel I.W. Lipworth ◽  
Douglas H.J. Elder ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Beta Agonist ◽  
Agonist Therapy ◽  
Long Acting ◽  
The Impact

Acute severe asthma (status asthmaticus)

2019 ◽  
Vol 40 (6) ◽  
pp. 406-409 ◽  
Author(s):  
Neha T. Agnihotri ◽  
Carol Saltoun
Keyword(s):  
Pulse Oximetry ◽  
Severe Asthma ◽  
Status Asthmaticus ◽  
Inhaled Corticosteroids ◽  
Airflow Obstruction ◽  
Forced Expiratory Volume ◽  
Beta Agonist ◽  
Medical Emergency ◽  
Acute Severe Asthma ◽  
Breath Sounds

Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy. It is a medical emergency that requires immediate recognition and treatment. Albuterol in combination with ipratropium bromide in the emergency department (ED) has been shown to decrease the time spent in the ED and the hospitalization rates. The benefits of ipratropium are not sustained after admission to the hospital. Oral or parenteral corticosteroids should be administered to all patients with acute severe asthma as early as possible because clinical benefits may not occur for a minimum of 6 to 12 hours. Viral respiratory infections are a common trigger for acute asthma; other causes include medical nonadherence, allergen exposure (especially pets and mold [e.g., Alternaria species]) in individuals who are severely atopic, nonsteroidal anti-inflammatory exposure in patients with aspirin allergy, irritant inhalation (e.g., smoke, paint), exercise, and insufficient use of inhaled or oral corticosteroids. The patient's history should focus on the acute assessment of asthma control and morbidity, including current use of oral or inhaled corticosteroids; the number of hospitalizations, ED visits, intensive care unit admissions, and intubations; the frequency of albuterol use; the presence of nighttime symptoms; activity intolerance; current medications; exposure to allergens; and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, difficulty speaking, refusal to recline < 30°, a pulse of >120 beats/min, and decreased breath sounds. More objective measures of airway obstruction via peak flow or forced expiratory volume in 1 second and pulse oximetry before oxygen administration usually are helpful. Pulse oximetry values of >90% are reassuring, although CO2 retention and a low partial pressure of oxygen may be missed.

A Survey of Food Allergen Control Practices in the U.S. Food Industry

2013 ◽  
Vol 76 (2) ◽  
pp. 302-306 ◽  
Author(s):  
STEVEN M. GENDEL ◽  
NAZLEEN KHAN ◽  
MONALI YAJNIK
Keyword(s):  
Public Health ◽  
United States ◽  
Food Allergy ◽  
Food Allergen ◽  
High Frequency ◽  
Food Industry ◽  
Adverse Reactions ◽  
The United States ◽  
Public Health Issue ◽  
The U.S

Despite awareness of the importance of food allergy as a public health issue, recalls and adverse reactions linked to undeclared allergens in foods continue to occur with high frequency. To reduce the overall incidence of such problems and to ensure that food-allergic consumers have the information they need to prevent adverse reactions, it is important to understand which allergen control practices are currently used by the food industry. Therefore, the U.S. Food and Drug Administration carried out directed inspections of registered food facilities in 2010 to obtain a broader understanding of industry allergen control practices in the United States. The results of these inspections show that allergen awareness and the use of allergen controls have increased greatly in the last decade, but that small facilities lag in implementing allergen controls.

scholarly journals Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma

2019 ◽  
Vol 55 (1) ◽  
pp. 1901147 ◽  
Author(s):  
Ingrid Maijers ◽  
Nethmi Kearns ◽  
James Harper ◽  
Mark Weatherall ◽  
Richard Beasley
Keyword(s):  
Dose Response ◽  
Oral Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Adrenal Suppression ◽  
Oral Steroid ◽  
Systemic Effects ◽  
High Dose ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Sparing Effect

BackgroundThe proportion of the efficacy of high-dose inhaled corticosteroids (ICS) in oral corticosteroid-dependent asthma that is due to systemic effects is uncertain. This study aimed to estimate the ICS dose–response relationship for oral corticosteroid-sparing effects in oral corticosteroid-dependent asthma, and to determine the proportion of oral corticosteroid-sparing effects due to their systemic effects, based on the comparative dose–response relationship of ICS versus oral corticosteroids on adrenal suppression.MethodsSystematic review and meta-analysis of randomised controlled trials reporting oral corticosteroid-sparing effects of high-dose ICS in oral corticosteroid-dependent asthma. In addition, reports of oral corticosteroid to ICS dose-equivalence in terms of adrenal suppression were retrieved. The primary outcome was the proportion of the oral corticosteroid-sparing effect of ICS that could be attributed to systemic absorption, per 1000 µg increase of ICS, expressed as a ratio. This ratio estimates the oral corticosteroid sparing effect of ICS due to systemic effects.Results11 studies including 1283 participants reporting oral corticosteroid-sparing effects of ICS were identified. The prednisone dose decrease per 1000 µg increase in ICS varied from 2.1 mg to 4.9 mg, depending on the type of ICS. The ratio of the prednisone-sparing effect due to the systemic effects per 1000 µg of fluticasone propionate was 1.02 (95% CI 0.68–2.08) and for budesonide was 0.93 (95% CI 0.63–1.89).ConclusionIn patients with oral corticosteroid-dependent asthma, the limited available evidence suggests that the majority of the oral corticosteroid-sparing effect of high-dose ICS is likely to be due to systemic effects.

Systemic effects of inhaled corticosteroids

2012 ◽  
Vol 18 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Pierre Ernst ◽  
Samy Suissa
Keyword(s):  
Inhaled Corticosteroids ◽  
Systemic Effects
Sign in / Sign up

Export Citation Format

Share Document