Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations

2019 ◽  
Author(s):  
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Copd Exacerbations

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 Fevipiprant, an oral prostaglandin DP2receptor (CRTh2) antagonist, in allergic asthma uncontrolled on low-dose inhaled corticosteroids

2017 ◽  
Vol 50 (2) ◽  
pp. 1700670 ◽  
Author(s):  
Eric D. Bateman ◽  
Alfredo G. Guerreros ◽  
Florian Brockhaus ◽  
Björn Holzhauer ◽  
Abhijit Pethe ◽  
...  
Keyword(s):  
Allergic Asthma ◽  
Low Dose ◽  
Inhaled Corticosteroids

scholarly journals Exacerbations of COPD

2018 ◽  
Vol 27 (147) ◽  
pp. 170103 ◽  
Author(s):  
Christian Viniol ◽  
Claus F. Vogelmeier
Keyword(s):  
Viral Infections ◽  
Inhaled Corticosteroids ◽  
Current Knowledge ◽  
Pneumococcal Vaccination ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Copd Exacerbations ◽  
Recommended Treatment ◽  
Number Of Patients ◽  
The Impact

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.

scholarly journals The Airways’ Mechanical Stress in Lung Disease: Implications for COPD Pathophysiology and Treatment Evaluation

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Pierachille Santus ◽  
Matteo Pecchiari ◽  
Francesco Tursi ◽  
Vincenzo Valenti ◽  
Marina Saad ◽  
...  
Keyword(s):  
Mechanical Stress ◽  
Inhaled Corticosteroids ◽  
Treatment Strategies ◽  
Cyclic Adenosine Monophosphate ◽  
Adenosine Monophosphate ◽  
Underlying Mechanism ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Copd Exacerbations ◽  
Long Acting

The airway epithelium stretches and relaxes during the normal respiratory cycle, and hyperventilation exaggerates this effect, resulting in changes in lung physiology. In fact, stretching of the airways influences lung function and the secretion of airway mediators, which in turn may cause a potentially injurious inflammatory response. This aim of the present narrative review was to illustrate the current evidence on the importance of mechanical stress in the pathophysiology of lung diseases with a particular focus on chronic obstructive pulmonary disease (COPD) and to discuss how this may influence pharmacological treatment strategies. Overall, treatment selection should be tailored to counterpart the effects of mechanical stress, which influences inflammation both in asthma and COPD. The most suitable treatment approach between a long-acting β2-agonists/long-acting antimuscarinic-agonist (LABA/LAMA) alone or with the addition of inhaled corticosteroids should be determined based on the underlying mechanism of inflammation. Noteworthy, the anti-inflammatory effects of the glycopyrronium/indacaterol combination on hyperinflation and mucociliary clearance may decrease the rate of COPD exacerbations, and it may synergistically improve bronchodilation with a double action on both the cyclic adenosine monophosphate (cAMP) and the acetylcholine pathways.

scholarly journals High- and low-dose allergen challenges in asthmatic patients using inhaled corticosteroids

2015 ◽  
Vol 79 (3) ◽  
pp. 523-532 ◽  
Author(s):  
Wha-Yong Lee ◽  
Thomas Southworth ◽  
Steven Booth ◽  
Dave Singh
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Asthmatic Patients

Low-dose adrenocorticotropin test reveals impaired adrenal function in patients taking inhaled corticosteroids.

1995 ◽  
Vol 80 (4) ◽  
pp. 1243-1246 ◽  
Author(s):  
J Broide ◽  
R Soferman ◽  
S Kivity ◽  
A Golander ◽  
G Dickstein ◽  
...  
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Adrenal Function

The short Synacthen test: a questionnaire survey of current usage

2012 ◽  
Vol 97 (10) ◽  
pp. 870-873 ◽  
Author(s):  
Charlotte Jane Elder ◽  
Pooja Sachdev ◽  
Neil Peter Wright
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
British Society ◽  
High Dose ◽  
Paediatric Endocrinology ◽  
Children With Asthma ◽  
Synacthen Test ◽  
The Uk ◽  
Meta Analyses ◽  
Short Synacthen Test

BackgroundSupported by meta-analyses, the low-dose Synacthen test (LDST) has gained in popularity, with many believing it to be more sensitive than the supraphysiological standard (250 µg) short ST (SSST), particularly when assessing children prescribed high-dose inhaled corticosteroids (HDICS). However, consensus is lacking about its specific clinical application, what is considered ‘low dose’ and how that dose is made up.MethodsTo ascertain current use of the short Synacthen test (SST), a questionnaire was emailed to members of the British Society of Paediatric Endocrinology and Diabetes in the UK and Ireland (N=257), requesting a response from each department (N=92). A reminder was sent a month later to members of departments which had not responded.ResultsThe authors received 39 replies, giving a response rate of 42%. All departments use the SST: 82% use an LDST, 87% use the SSST and 69% use both. The 1 µg dose was used by 44% of hospitals, with the other 56% using seven different doses based on age, weight and body surface area. There were 14 different methods of preparing the low dose test. Additionally, variations in the timings of cortisol sampling and the diagnostic cut-offs for adrenal insufficiency were found. Increased requests for SSTs in children with asthma prescribed HDICS were noted by 44% of respondents, with 67% reporting the detection of adrenal suppression in this group.ConclusionStandardisation of the SST is required to address the considerable variation in the methodology and application of this test in the UK and Ireland.

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