Steroids Blog

Even though asthma is one of the major reasons for admissions to hospitals and a common chronic disease among young children yet 26-45 percent of children face inadequate asthma control, as per a review in CMAJ (Canadian Medical Association Journal).

This review was produced as an initiative of the Canadian Thoracic Society and incorporated the latest scientific information derived from randomized controlled trials since the Canadian Pediatric Asthma Consensus Guidelines were published in 2003.

From Sciencedaily.com:

The review provides key points for distinguishing between transient asthma and chronic asthma in preschoolers and information on managing both types.

For children with intermittent asthma, using inhaled corticosteroids only during attacks does not appear to be effective. Regular therapy with inhaled steroids should be used for children with more severe intermittent or persistent symptoms. Treatment with leukotriene receptor antagonists during the viral season may help to reduce symptoms and visits to health care providers. The possibility of another condition should be considered if children do not respond to optimal therapy.

The authors stated that more research is pending to examine the effectiveness of treatment options in young children.

According to a research published in the New England Journal of Medicine, an antibiotic was found to be effective for treating acute asthma attacks. It was revealed that Telithromycin, an antibiotic, can be used to provide relief to patients suffering from asthma.

The team of involved researchers was from Imperial College London, the University of Milan, the University of Auckland, the National Jewish Medical Centre, USA, G.R. Micro Ltd, London, and sanofi-aventis, USA.

From News-Medical.Net:

Professor Sebastian Johnston from Imperial College London, who led the research, said: “Traditionally antibiotics have not proven effective in treating asthma attacks, but this development could open up a whole new area of research in the treatment of asthma. Although we’re not sure about the exact mechanism which caused this antibiotic to be effective, this study indicates it does clearly have a beneficial effect. We still need further trials to confirm these results, to investigate the mechanisms of action of this treatment, to see if the same benefits are seen with other related antibiotics and to see which patients are most likely to benefit.”

It is important to note here that treatment for serious asthma attacks can involve the use of steroids for controlling inflammation of the lungs and bronchodilators to open airways.

A cataract is a clouding that develops in the eye. It may develop in the crystalline lens or in its envelope. There different types of cataract. Among those are congenital cataracts and secondary cataracts. Under secondary cataracts is a type known as drug-induced cataract. This type is usually due to corticosteroids use.

A population-based study was recently conducted by the Centre for Vision Research, University of Sydney in Australia. They obtained initial baseline information from asthma patients, who have been using either oral steroid for a month, or have used inhaled corticosteroid at least once. The study then conducted examinations five or ten years after initial baseline information were obtained.

Clinical trials suggest that long-term steroid use and its cumulative dosage increased the patient’s risk for developing cataracts. There were two types of cataract found to stem from steroid use; the nuclear cataract and the posterior subcapsular cataract. The nuclear cataract develops in the center of the lens while in posterior subcapsular cataract (PSC) the cataract develops in the area of the lens.

These findings further lead to additional studies to determine the effectivity of a combined oral and inhaled steroids therapy against using inhaled steroids alone. They found out that both exhibited similar effects. Clinicians therefore, must be cautious in prescribing the combined therapy to their patients as this may cause higher risk for developing cataracts.

According to Medical News Today:

“Our findings could mean that combined steroid use, when it results in high cumulative dosage over relatively long periods, increases risks for two types of cataract,” said lead researcher, Jie Jin Wang, MMed, PhD, Centre for Vision Research. “When clinicians prescribe both steroid forms, the cumulative, combined dose should be considered. Also, recent clinical trials indicate that combined steroids are not more effective than inhaled steroids alone in treating asthma.” He added that further investigation is needed to determine whether asthma plays a role in nuclear cataract development.

A recent study conducted in UK tested a new asthma management plan. Instead of the previously advised double dose of inhaled corticosteroids, the researchers increased the dosage of beclomethasone inhaler to a fourfold.

This study aims to find the best possible treatment in preventing asthma exacerbations. They observed asthma patients under maintenance of oral corticosteroids. They were then advised to adopt the quadruple dose. When the peak expiratory flow fell, dose was increased from 200 μg to 1000 μg from one to two days.

The study led to an amazing drop in the number of exacerbations needing oral corticosteroids in patients who used the active drug compared to patients who used placebo inhalers. This reduction showed as much as twenty-one percent lower than the usual fifty percent.

The study authors said that other small trials found no significant result if the drug is to be increased two-fold than if the drug is to be increased four-fold. Furthermore, according to the researchers in the American Journal of Respiratory and Clinical Care Medicine, the overall reduction in exacerbation proves to be an insignifcant result since some of the patients from the treatment group did not adopt the quadruple dose advice.

From 6 minutes:

In a studyinvolving 400 asthma patients, management plans were adopted that advised a quadrupling of the usual dose of 200 to 1000 µg of beclomethasone inhaler (or equivalent) when the peak expiratory flow fell by 15% on two consecutive days or by 30% on one day.This led to a marked reduction in the number of exacerbations needing oral corticosteroids (21% v 50%) in patients who used the active rather than placebo inhalers, the study authors say.

However, the overall reduction in exacerbations was not statistically significant because some patients did not adopt the quadrupling dose advice, say the researchers in the American Journal of Respiratory and Clinical Care Medicine (online 9 July).

As per a latest study conducted by the National Heart, Lung and Blood Institutes Asthma Clinical Research Network and Stanley Szefler, M.D., lead author on the paper and Head of Pediatric Clinical Pharmacology at National Jewish Medical and Research Center, it was found that low to medium doses of inhaled steroids can benefit patients suffering from persistent asthma.

Szefler said that individual patients may respond in a different manner than others when administered with inhaled steroids and this is where other therapies may be implemented if low to medium doses of inhaled steroids fail to bring clear benefits for them.

The study clearly indicated that inhaled steroids are usually more than enough to bring improvements in the functioning of the lungs in patients with persistent asthma.

From News.Bio-Medicine.Org:

“Dr. Szefler recommends that doctors whose patients do not respond with low to medium doses of inhaled steroids consider supplementing them with non-steroidal medications, such as long-acting beta agonists and leukotriene modifiers, before prescribing high doses of inhaled steroids. When high doses of steroids are used for several years, they may be associated with an increased risk for adverse effects, such as osteoporosis, cataracts and glaucoma. However, higher doses of inhaled steroids may still be needed to help some patients control their asthma, said Dr. Szefler. He advises doctors to monitor any patients taking high doses to determine whether the benefits outweigh the risk for adverse effects. The new findings indicate that benefits vary widely for individual patients.

The research team studied 30 patients with persistent asthma. The patients received three different doses of an inhaled steroid, each administered for six weeks at a time. The researchers examined two inhaled steroids in this study, fluticasone propionate (FloventTM), and beclomethasone dipropionate (VancerilTM) both in the canister form along with a spacer device. They evaluated benefits primarily by measuring lung function and airway sensitivity. Cortisol levels were measured to gauge the effect of the inhaled steroid on the body’s normal function and the risk for adverse effects.

To the research teams surprise, eight of the 21 patients (38%) who completed all lung function tests showed less than a 5% increase in lung function at any dose, much less than expected. Five (23%) had a 5% to 15% percent increase in lung function, while eight (38%) had more than 15% improvement in lung function. A similar degree of variability in response was shown for the change in measures of airway sensitivity.”

The study also suggested that patients who have been administered with high doses of inhaled steroids need to be monitored so that it could be determined whether the benefits of such high doses outweigh the risks for adverse effects.

This study is regarded as quite important as it was able to highlight considerable variations in responses to the prescribed medications. The study also helped in the initiation of a whole new area of research that seems to have an ability to improve management of asthma.

Studies shown by Childhood Asthma Management Program (CAMP) clinical trial reveals that a continued treatment of asthma along with steroids leads to a better result than not using them. The trial as conducted on 1000 children aged between 5-12 and were divided into three groups, out of which one was given the steroid budesonide twice-daily and an inhaled corticosteroid medication; the other received nedocromil, an inhaled non-steroid medication; and third group received a placebo.

From science daily:

Results from the original CAMP trial showed that using budesonide twice daily led to fewer hospitalizations and urgent care visits, fewer days in which additional asthma medications were needed and a reduced need for albuterol, a fast-acting drug for relief of acute asthma symptoms. Using nedocromil twice daily reduced urgent care visits and courses of oral steroids for severe symptoms, but did not affect the number of hospitalizations, symptoms or airway responsiveness.

“The conclusion is that some kids get better, but the doctor, family and the patient have to pay attention to the symptoms,” Strunk said. “Some of the kids are going to need medicine, and they have to be honest about that possibility.”

Though with age, the symptom of asthma is reduced since the patient gets acquainted with the disease and manages on its own whereas it still resides in the body.

As studied by Robert C. Strunk, M.D., a Washington University pediatrician at St. Louis Children’s Hospital and lead author of the study, after five years that Inhaled corticosteroids such as budesonide was most effective form of anti-inflammatory treatment for asthma by controlling symptoms and improving pulmonary function, led to fewer hospitalizations and urgent care visits. Unlike nedocromil twice daily reduced urgent care visits and courses of oral steroids for severe symptoms, but did not affect the number of hospitalizations, symptoms or airway responsiveness.

In the recently held World Asthma Day, Prof. Dr. Nadeem Rizvi, Pakistan Chest Society explained the main causes of asthma. He stated that asthma cases in urban areas are relatively higher due to the presence of pollution. Professor Rizvi also added that asthma symptoms such as shortness of breath, cough and wheezing should be properly addressed by doctors to avoid further complications. However, he mentioned that these signs are usually taken for granted by most doctors who just give antibiotics to the patients. He said that this procedure is wrong because physicians should examine the patients properly.

From The International News:

Asthma cannot be cured, but in majority of the cases it can be effectively controlled if we change our urban lifestyle, said Prof. Dr Nadeem Rizvi, Pakistan Chest Society Vice President and head of the chest medicine department at Jinnah Postgraduate Medical Centre.

“Due to the misconception that asthma’s symptoms only include shortness of breath, most doctors tend to ignore other symptoms such as cough and wheezing, especially amongst children. For persistent coughs, patients are immediately prescribed antibiotics, which is wrong,” he said.

He said that inhaled steroids is the best available treatment for asthma patients to date but due to the taboo attached with using an inhaler in public, most patients avoid opting for this line of treatment. “Also, steroids taken through an inhaler have no side effects as against taken in the form of tablets. Inhalers work best as it directly prevents inflammation of the airways,” he said stressing.

According to Prof. Rizvi that inhaled steroids is still the best treatment for asthmatic people. The professor stated that steroids in asthma inhalers bear no side effects compared to oral forms. Lastly, he pointed out that people should disregard the misconceptions on inhaled steroids, so that the disease can be treated.