Asthma Flares Research Articles

Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children.

We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known:• All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them.What is New:• We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs. Supplementary informationThe online version contains supplementary material available at 10.1007/s00431-021-04306-6.

Ambulatory Care Sensitive Conditions in Pediatrics: Time for a Reassessment.

Ambulatory Care Sensitive Conditions in Pediatrics: Time for a Reassessment.

Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma.

PurposeTo evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia.MethodsA cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services.ResultsA total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81–96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4–91.3) and between EDs and paediatric wards (p=9.4×10−9); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2–3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up.ConclusionThere are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.

An asthma plan

An asthma plan

Impact on quality of life and safety of sublingual and subcutaneous immunotherapy in children with severe house dust mite and pollen-associated allergic rhinoconjunctivitis

BackgroundPollen and house dust mite (HDM) subcutaneous immunotherapy (SLIT) and pollen subcutaneous immunotherapy (SCIT) are effective therapies for children with allergic rhinoconjunctivitis (AR). There are no previous direct comparative studies investigating quality of life (QoL) of all three immunotherapy regimes. The aim of this study was to compare QoL and safety in children receiving these immunotherapies for AR.MethodsDemographic characteristics, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analogue (VAS) scores were assessed in 249 children undergoing HDM and pollen immunotherapy at a UK specialist paediatric centre between 2007 and 2019.ResultsAll three immunotherapy regimes led to a > 50% improvement in QoL and VAS after 3 years of therapy, with significant improvements by the end of the first year (p < 0.05) and further improvements between 1 and 3 years (p < 0.05). Age, gender, ethnicity and route of administration had no significant bearing on efficacy. Older, polysensitised children and those receiving HDM SLIT were all more likely to discontinue their treatment (all with p < 0.05). The only patient to suffer from anaphylaxis requiring intramuscular adrenaline, and 80% experiencing exacerbations of their asthma had received pollen SCIT.ConclusionsPollen SCIT and pollen and HDM SLIT all lead to significant improvements in QoL. The risk of anaphylaxis is low, but SCIT is associates with a 1 in 5 chance of asthma flares in the days after its administration. Discontinuation of therapy is more frequent in older, polysensitised children, and those undergoing HDM immunotherapy.

Spacers Versus Nebulizers in Treatment of Acute Asthma - A Prospective Randomized Study in Preschool Children

N Mitselou, G Hedlin, CA Hederos. J Asthma. 2016;53(10):1059–1062 To compare administration of bronchodilators by nebulizers with delivery by metered dose inhalers (MDIs) with spacers and to evaluate the clinical effect of the treatment of acute asthma in preschool children. Children 0–6 years of age who presented to the emergency department with viral infection–associated wheezing or acute asthma flares. A prospective randomized clinical trial in a pediatric emergency department (PED). Preschool children …

Adjunct Therapies for Refractory Status Asthmaticus in Children.

Asthma exacerbation is a common reason for children to present to the emergency department. If primary therapies fail to halt the progression of an asthma flare, status asthmaticus often leads to hospital, and potentially ICU, admission. Following the initial administration of inhaled β agonists and systemic corticosteroids, a wide array of adjunct medical therapies may be used to treat status asthmaticus. Unfortunately, the data supporting the use of these adjunct therapies are often unclear, conflicting, or absent. This review will present the physiologic basis and summarize the supporting data for a host of adjunct therapies, including ipratropium, intravenous β agonists, methylxanthines, intravenous and inhaled magnesium, heliox (helium-oxygen mixture), ketamine, antibiotics, noninvasive ventilation, inhaled anesthetics, and extracorporeal membrane oxygenation. Finally, we present a suggested care map for escalating to these therapies in children with refractory status asthmaticus.

Development of a Bronchial Thermoplasty Program at the VA Boston Healthcare System

SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Bronchial thermoplasty (BT) is a treatment for severe persistent asthma which uses bronchoscopically delivered radiofrequency energy to induce smooth muscle atrophy thereby decreasing bronchoconstriction. The Pulmonary and Allergy Section of the VA Boston Healthcare System was the first Department of Veterans Affairs Medical Center to implement bronchial thermoplasty for our veteran population. METHODS: The VA Boston serves as a regional referral center for both Pulmonary and Allergy patients with a catchment area encompassing the northern New England region. The Asthma clinic also delivers care via a network of community-based outpatient clinics throughout Massachusetts, Rhode Island, New Hampshire and Maine. Via this network, referring providers were educated about the principles behind BT and its benefits in the treatment of patients with uncontrolled severe persistent asthma despite maximal medical therapy. Pulmonologists at nearby VA Medical Centers were also individually contacted to aprise them of the availability of BT. Patients screened for bronchial thermoplasty were evaluated for immunotherapy and omalizumab. All were on maximal medical therapy and had continued asthma flares. Outreach to providers supporting the procedure included presentations on the principles of BT, its relationship to conventional diagnostic bronchoscopy as well as expectations for level of anesthesia and duration of the procedure. All treatments were performed under moderate to deep sedation with anesthesiology support. Patients were pre-treated with prednisone as per the AIR2 trial and received an anti-sialagogue as well as a cough suppressant on the day of the procedure. Pre- and post-procedure spirometry were obtained to verify that patient's were near their baseline lung function and that they were safe for discharge subsequent to the procedure. RESULTS: In the first year, five patients with severe persistent asthma completed treatment. Referrals were drawn from within the Medical Center as well as from other regional centers. All had severe persistent asthma symptoms with elevated Astma Control Test scores as well as significant bronchodilator reversibility on spirometry. Patients had undergone allergy testing as well as immunotherapy or treatment with anti-IgE therapy where appropriate. Patients underwent the recommended three procedures at one month intervals under moderate sedation. ACT scores improved following treatment reflecting improved asthma control with decreased prednisone requirements, daily symptoms and exacerbations. CONCLUSIONS: Successful implementation of a bronchial thermoplasty program requires education of referring and participating providers as well as close coordination between multiple departments within the medical center on the day of the procedure. Close follow-up and outreach to patients ensures that the multiple procedures required are successfully completed. CLINICAL IMPLICATIONS: Development of regional bronchial thermoplasty centers in the VA network will help to serve the needs of our veterans with severe persistent asthma who have failed conventional medications and immunotherapy. DISCLOSURE: The following authors have nothing to disclose: Ting-hsu Chen, Claire Murphy, Ronald Goldstein No Product/Research Disclosure Information

Anti-IgE Monoclonal Antibody (Omalizumab) in Refractory and Relapsing Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss): Data on Seventeen Patients.

To describe the efficacy and safety of omalizumab, an anti-IgE monoclonal antibody, in patients with refractory and/or relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA). We conducted a nationwide retrospective study including EGPA patients who received omalizumab. Response was defined as the absence of asthma and/or sinonasal exacerbations with a prednisone dosage of ≤7.5 mg/day (complete response) or >7.5 mg/day (partial response). Seventeen patients (median age 45 years) received omalizumab for severe steroid-dependent asthma (88%) and/or sinonasal involvement (18%). After a median follow-up of 22 months, 6 patients (35%) achieved a complete response, 5 patients (30%) achieved a partial response, and 6 patients (35%) had no improvement. The median Birmingham Vasculitis Activity Score decreased from 2.5 at baseline to 0.5 at 12 months. The median number of exacerbations per month decreased from 1 at baseline to 0 at 12 months, and the median forced expiratory volume in 1 second increased from 63% of the percent predicted at baseline to 85% of the percent predicted at 12 months. The median prednisone dosage decreased from 16 mg/day at baseline to 11 mg/day at 6 months and 9 mg/day at 12 months. Omalizumab was discontinued in 8 patients (47%) during follow-up, because of remission (12.5%), adverse event despite disease remission (12.5%), refractory disease (25%), or relapse (50%). Relapses included retrobulbar optic neuritis attributable to EGPA in 2 patients and severe asthma flare in 2 others. The results of this study suggest that omalizumab may have a corticosteroid-sparing effect in EGPA patients with asthmatic and/or sinonasal manifestations, but reducing the corticosteroid dose may also increase the risk of severe EGPA flares, which raises the question of the safety of omalizumab in patients with EGPA.

Asthma and asthma-related health care utilization among people without disabilities and people with physical disabilities

BackgroundPrevious research has shown that people with disabilities have higher rates of some chronic diseases and receive poorer disease-specific care than their counterparts without disabilities. Yet, little is known about the relationship between asthma and disability. ObjectiveThis study examines whether differences in the prevalence of asthma, asthma flare, and asthma-related measures of health care quality, utilization and cost exist among people with physical limitations (PL) and without any limitations. MethodsData from the 2004–2010 Medical Expenditure Panel Survey were pooled to compare outcomes for working-age adults (18–64) with PL to those with no limitations. ResultsPeople with PL had higher rates of asthma (13.8% vs. 5.9%, p < 0.001) and recent asthma flare (52.6% vs. 39.6%, p < 0.001) than people without limitations. There were no differences in health care quality, utilization or cost between people with PL and people without limitations in multivariate analyses. ConclusionsAlthough there are no differences in asthma-related quality or utilization of health care, people with PL have poorer asthma control than people without limitations. Research is needed to determine what factors (e.g., focus on other acute ailments, perceptions that asthma control cannot improve) are related to this outcome. Future research must also examine differences in asthma severity, and its impact on asthma control and health care-related outcomes, among people with and without disabilities.

Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT.

Electronic health record (EHR)-linked patient portals are a promising approach to facilitate shared decision-making between families of children with chronic conditions and pediatricians. This study evaluated the feasibility, acceptability, and impact of MyAsthma, an EHR-linked patient portal supporting shared decision-making for pediatric asthma. We conducted a 6-month randomized controlled trial of MyAsthma at 3 primary care practices. Families were randomized to MyAsthma, which tracks families' asthma treatment concerns and goals, children's asthma symptoms, medication side effects and adherence, and provides decision support, or to standard care. Outcomes included the feasibility and acceptability of MyAsthma for families, child health care utilization and asthma control, and the number of days of missed school (child) and work (parent). Descriptive statistics and longitudinal regression models assessed differences in outcomes between study arms. We enrolled 60 families, 30 in each study arm (mean age 8.3 years); 57% of parents in the intervention group used MyAsthma during at least 5 of the 6 study months. Parents of children with moderate to severe persistent asthma used the portal more than others; 92% were satisfied with MyAsthma. Parents reported that use improved their communication with the office, ability to manage asthma, and awareness of the importance of ongoing attention to treatment. Parents in the intervention group reported that children had a lower frequency of asthma flares and intervention parents missed fewer days of work due to asthma. Use of an EHR-linked asthma portal was feasible and acceptable to families and improved clinically meaningful outcomes.

Fungal septal abscess complicating maxillary sinus fungus balls in an immunocompetent host.

Background:Fungal infections of the nasal cavity can be destructive entities that are typically seen in immunocompromised hosts. We present a case of a localized fungal abscess of the nasal septum in an immunocompetent host after endoscopic treatment of maxillary sinus fungus balls.Method:A 51-year-old woman with a history of asthma and recent treatment with oral steroids presented with bilateral maxillary sinus mycetomas. She underwent endoscopic sinus surgery. The postoperative course was complicated by an asthma flare, which required oral steroids. The patient returned with nasal obstruction, and results of a physical examination were consistent with a nasal septal abscess. Drainage was attempted, and cultures showed fungal elements. The abscess reaccumulated, and the patient was referred to our institution. Operative drainage was performed with placement of a catheter in the septal abscess cavity. Forty-eight hours of amphotericin irrigations were performed through this site. The patient was started on oral antifungal therapy. Results of an immune workup, including testing for human immunodeficiency virus and assessing immunoglobulin levels, were negative. Final fungal cultures grew Scedosporium apiospermum sensitive to voriconazole. The patient completed therapy without further recurrence. Follow-up at 6 months demonstrated no further recurrence of her fungal septal infection.Conclusion:Sinonasal fungal infections rarely occur in immunocompetent hosts. The septum may have been seeded during the endoscopic sinus surgery. The use of oral steroids may have been a risk factor for the development of an aggressive nasal septal fungal abscess in this patient. This is the first reported case of a nasal septal abscess in an otherwise immunocompetent host with S. apiospermum.

Serum apelin-12 in bronchial asthma

Aim. To evaluate the serum level of apelin-12 in patients with bronchial asthma. Methods. 11 healthy controls and 29 patients with bronchial asthma were examined (among them 19 with atopic asthma and 10 with non-atopic asthma). Serum apelin-12 levels were measured by enzyme immunoassay (ELISA, MyBioSource, USA). SPSS (Statistical Package for the Social Science, V. 13) for Windows was used for statistical analysis. Results. The phenomenon of low apelin-12 serum levels was revealed in patients with bronchial asthma. The most significant decrease of apelin-12 levels was noticed in atopic bronchial asthma. The apelin-12 levels were significantly correlated with a number of indices of bronchial obstruction. Apelin-12 levels correlated with a number of indicators characterizing the grade of bronchial obstruction. Moreover, low apelin-12 levels were suggesting bronchial obstruction. Besides, significant reverse correlation of apelin-12 levels and allergic sensitization was revealed. In addition, statistically significant relation between apelin-12 serum level and peripheral blood eosinophil and lymphocyte counts was revealed. There was an inverse association between apelin-12 serum level and peripheral blood neutrophil count. Conclusion. Literature analysis and our own results allow us to suppose the possible protective role of apelin-12 in bronchial asthma flare. Further studies of apelin-12 and of other isoforms of adipokines are needed for better understanding of the disease.

The Incidence of Hyponatremia with Two Commonly Prescribed Purgatives for Colonoscopy - Polyethylene Glycol 3350 with Sports Drink (PEG-SD) Compared to Polyethylene Glycol with Electrolyte Solution (PEG-ELS): ACG/AstraZeneca Fellow Award

Purpose: Polyethylene glycol 3350 combined with a sports drink (PEG-SD) is a hypo-osmotic purgative commonly used for colonoscopy (“colon”). Little safety data are available for this non-FDA approved purgative. The purpose was to evaluate the effect of PEG-SD on serum electrolytes. Methods: Single center, prospective, randomized, investigator-blind comparison of PEG-ELS to PEG-SD for outpt colon. SD = Lemon-Lime Gatorade®; PEG-ELS = MoviPrep®. PEG-ELS regimen was 1L + 500cc clears at 6 pm and 4 hrs before colon. PEG-SD regimen was a single 10 mg dose of bisacodyl at 3 pm, and 1L SD with 119 g PEG 3350 at 6 pm and 4 hrs before colon. Diet was a low residue breakfast day prior followed by clears up to 2.5 hrs before colon. Baseline labs were obtained 2-5 days prior to colon, and repeated immediately before and after colon. Pts completed side effect (SE) questionnaires prior to colon. Changes in levels of electrolytes and eGFR were computed as the difference between the lowest value on the day of colonoscopy and baseline. Preparation was graded as adequate (good or excellent) or inadequate (fair, poor). Primary endpoint was development of hyponatremia (Na <135 mmol/L) day of colon. The study had 80% power to detect a 3-fold difference in incidence of hyponatremia between the two groups (5% vs 14%). Results: 389 pts were randomized between 7/2010 and 6/2012, and 25 were excluded (13 for hyponatremia at baseline). 364 analyzed pts ingested purgative and had baseline and day of colon labs (180 PEG-SD, 184 PEG-ELS). The groups were well matched except for a higher fraction of women and Blacks in PEG-ELS group. 7 pts (3.9%) in PEG-SD and 4 pts (2.2%) in PEG-ELS developed hyponatremia (OR = 0.55, exact 95% CI: 0.12 to 2.21, p = 0.376). For these 11 pts, the mean Na change was -5.3, SD = 2.7, with no instances of Na <131 mmol/L. Changes in electrolytes from baseline were small but significantly greater with PEG-SD for Na, potassium (K), and chloride (Cl) (PEG-SD vs PEG-ELS: ΔNa -0.7 vs 0.5, p = 0.001; ΔK -0.2 vs -0.1, p = 0.022; ΔCl -0.9 vs 0.5, p = 0.001). Neither group had a significant change in renal function. There was no significant difference in SEs or prep completion between the 2 groups. 1 pt in PEG-SD group had an acute MI after completing AM dose, and 1 pt in PEG-ELS group had an asthma flare in AM after completing PM dose. Both occurred prior to colon. Preparation adequacy was similar between the study groups (PEG-SD = 87% vs PEG-ELS = 86%), but there were more excellent preparations with PEG-ELS (52% vs 30%). Conclusion: Hyponatremia is rare and not significantly increased with PEG-SD as compared to PEG-ELS. Greater, but very modest, electrolyte changes occur with PEG-SD. Preparation completion, quality, and SEs are similar with both purgatives. Disclosure: Dr. Kastenberg - Salix Pharmaceuticals: consultant, research support This research was supported by an industry grant. Salix Pharmaceuticals provided financial support/research grant.

Off-label use of omalizumab in cases refractory to approved treatments

BackgroundOmalizumab is an antibody used for the treatment of asthma with high blood levels of IgE (>76 IU/ml), as it is not expected to show much efficacy when levels are...

The Effect of Emergency Department Crowding on Length of Stay and Medication Treatment Times in Discharged Patients With Acute Asthma

This study sought to determine if emergency department (ED) crowding was associated with longer ED length of stay (LOS) and time to ordering medications (nebulizers and steroids) in patients treated and discharged with acute asthma and to study how delays in ordering may affect the relationship between ED crowding and ED LOS. A retrospective cohort study was performed in adult ED patients aged 18 years and older with a primary International Classification of Diseases, 9th Revision (ICD-9), diagnosis of asthma who were treated and discharged from two EDs from January 1, 2007, to January 1, 2009. Four validated measures of ED crowding (ED occupancy, waiting patients, admitted patients, and patient-hours) were assigned at the time of triage. The associations between the level of ED crowding and overall LOS and time to treatment orders were tested by analyzing trends across crowding quartiles, testing differences between the highest and lowest quartiles using Hodges-Lehmann distances, and using relative risk (RR) regression for multivariable analysis. A total of 1,716 patients were discharged with asthma over the study period (932 at the academic site and 734 at the community site). LOS was longer at the academic site than the community site for asthma patients by 90 minutes (95% confidence interval [CI] = 79 to 101 minutes). All four measures of ED crowding were associated with longer LOS and time to treatment order at both sites (p < 0.001). At the highest level of ED occupancy, patients spent 75 minutes (95% CI = 58 to 93 minutes) longer in the ED compared to the lowest quartile of ED occupancy. In addition, comparing the highest and lowest quartiles of ED occupancy, time to nebulizer order was 6 minutes longer (95% CI = 1 to 13 minutes), and time to steroid order was 16 minutes longer (95% CI = 0 to 38 minutes). In the multivariable analysis, the association between ED crowding and LOS remained significant. Delays in nebulizer and steroid orders explained some, but not all, of the relationship between ED crowding and ED LOS. Emergency department crowding is associated with longer ED LOS (by more than 1 hour) in patients who ultimately get discharged with asthma flares. Some but not all of longer LOS during crowded times is explained by delays in ordering asthma medications.

Ambient ultrafine particles provide a strong adjuvant effect in the secondary immune response: implication for traffic-related asthma flares.

We have previously demonstrated that intranasal administration of ambient ultrafine particles (UFP) acts as an adjuvant for primary allergic sensitization to ovalbumin (OVA) in Balb/c mice. It is important to find out whether inhaled UFP exert the same effect on the secondary immune response as a way of explaining asthma flares in already-sensitized individuals due to traffic exposure near a freeway. The objective of this study is to determine whether inhalation exposure to ambient UFP near an urban freeway could enhance the secondary immune response to OVA in already-sensitized mice. Prior OVA-sensitized animals were exposed to concentrated ambient UFP at the time of secondary OVA challenge in our mobile animal laboratory in Los Angeles. OVA-specific antibody production, airway morphometry, allergic airway inflammation, cytokine gene expression, and oxidative stress marker were assessed. As few as five ambient UFP exposures were sufficient to promote the OVA recall immune response, including generating allergic airway inflammation in smaller and more distal airways compared with the adjuvant effect of intranasally instilled UFP on the primary immune response. The secondary immune response was characterized by the T helper 2 and IL-17 cytokine gene expression in the lung. In summary, our results demonstrated that inhalation of prooxidative ambient UFP could effectively boost the secondary immune response to an experimental allergen, indicating that vehicular traffic exposure could exacerbate allergic inflammation in already-sensitized subjects.

The Adjuvant Effect of Ambient Particulate Matter Is Closely Reflected by the Particulate Oxidant Potential

The Adjuvant Effect of Ambient Particulate Matter Is Closely Reflected by the Particulate Oxidant Potential

The “Steroid Dementia Syndrome”: A Possible Model of Human Glucocorticoid Neurotoxicity

Glucocorticoid medications cause neurotoxicity in animals under certain circumstances, but it is not known if this occurs in humans. We present the case of a 10-year-old boy with no prior psychiatric history and no prior exposure to glucocorticoid medication who received a single 5-week course of glucocorticoids for an acute asthma flare. Beginning during steroid treatment, and persisting for over 3 years after stopping treatment, he showed a significant decline from his pre-morbid academic performance and estimated IQ, verified by longitudinally administered testing and school records. Neuropsychological tests that are sensitive to glucocorticoid-induced cognitive impairments revealed global cognitive deficits consistent with primary hippocampal and prefrontal cortical dysfunction. The patient has a fraternal twin brother, who had previously achieved academic milestones in parallel with him; the patient began falling behind his twin in academic, developmental and social areas shortly after the steroid treatment. In the 3 years since stopping steroid medication, the patient has shown gradual but possibly incomplete resolution of his cognitive deficits. Quantitative brain magnetic resonance imaging (MRI), performed 38 months after steroid exposure revealed no gross abnormalities, but the patient's hippocampal volume was 19.5% smaller than that of his twin, despite the patient having a larger overall intracranial volume. Single photon emission computed tomography (SPECT) imaging, performed at the same time, suggested subtly decreased activity in the left posterior frontal and left parietal lobes. This case, along with others reported in the literature, suggests that certain individuals develop a “steroid dementia syndrome” after glucocorticoid treatment. Although this syndrome is uncommon, it is consistent with evolving theories of the neurotoxic or neuroendangering potential of glucocorticoids in some situations.

Analysis of Steroid Treatment of First Wheezing Episode

Analysis of Steroid Treatment of First Wheezing Episode