Course Of Oral Prednisolone Research Articles

Idiopathic thrombocytopenic purpura and hypokalaemic dRTA with compensated haemolysis and striking acanthocytosis in a band 3 (SLC4A1/AE1) A858D homozygote

Dear Editor, The pleiotropic effects of mutations of the band 3 (SCL41/ AE1) gene which result in familial distal renal tubular acidosis (dRTA) and red cell abnormalities are now wellestablished [1]. The occurrence of dRTA and haemolytic anaemia in A858D homozygotes was first reported recently in children from India [2] and Oman [3]. This letter describes certain unusual features in an Omani adolescent A858D homozygote. A 17-year-old Omani Arab youth, son of a consanguineous marriage presented with complaints of bleeding gums and easy bruising for a few weeks. Also, he reported experiencing progressively severe muscle weakness which, after several weeks, culminated in his inability to rise out of bed. He was of normal stature and weight with mild scleral icterus, generalised skin purpura, buccal mucosal petechiae and mild splenomegaly; hypotonia, hyporeflexia and quadriparesis were additional findings. Investigations showed a normal haemoglobin (Hb— 131 g/L), haematocrit (0.39) and white blood cell count, but an increased reticulocyte count (373.5×10/L) and a very low platelet count (6.0×10/L). Freshly drawn blood films revealed polychromasia, a striking predominance of acanthocytes (70–85 %), a moderate number of ovalocytes and a few other poikilocytes (Fig. 1). Ahaptoglobinaemia, unconjugated hyperbilirubinaemia, normal serum immunoglobulins and a negative antiglobulin test provided supportive evidence for a non-immune-compensated haemolysis. The bleeding problem was diagnosed as autoimmune idiopathic thrombocytopenic purpura (ITP) despite negative results of platelet and other relevant autoantibody tests [4]. Associated autoimmune diseases such as SLE and Sjogren's syndrome [5] were ruled out. Quadriparesis was due to hypokalaemia (serum K, 2.5 mmol/L) secondary to complete dRTA characterised essentially by hyperchloraemic acidosis (Cl, 117 mmol/ L), reduced serum HCO3 − (18 mmol/L) concentration and normal values of serum anion gap, blood urea, serum creatinine, arterial blood pH and blood gases, coupled with a positive urine anion gap and a persistent urine pH >6.0; the patient refused a urine acidification test. DNA analysis revealed a homozygous A858D (alanine → aspartic acid) mutation of the SLC41/AE1 gene. Following a 3-week course of oral prednisolone, bleeding symptoms ceased, platelet count was normalised (317×10/ L) and muscle weakness improved considerably on oral potassium chloride, sodium bicarbonate and spironolactone. During the ensuing years, because of poor drug compliance, he was hospitalised several times with hypokalaemic limb pareses (serum K levels varying between 2.0 and 3.1 mmol/L), but his blood counts have remained normal throughout. Ultrasonography later revealed bilateral J. U. Rehman : S. Al Zadjali :N. A. Fawaz : S. Al Kindi Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, PO Box 35, Muscat 123, Sultanate of Oman

The Effect of a Postoperative Course of Oral Prednisone on Postoperative Morbidity following Childhood Tonsillectomy

Tonsillectomy is a common procedure with a wide range of described operative techniques and usage of perioperative medications. Single-dose intraoperative dexamethasone has been shown to decrease postoperative nausea and pain and improve return to normal diet. The aim was to determine if a course of oral postoperative steroids would further decrease postoperative morbidity following tonsillectomy in children. Randomized, placebo-controlled, double-blinded trial. Power analysis recommended 198 participants. A university hospital and private hospital. The authors compared a 5-day course of oral prednisolone with placebo in a pediatric population (3-16 years) undergoing tonsillectomy to assess effects on postoperative pain, nausea, and vomiting and return to normal function. They also assessed the effect of corticosteroids on sleep duration and aspects of sleep quality. The results showed no significant difference between the 2 groups when analyzed for differences in the above variables both overall and at each of the postoperative 10 time points (pain, P = .478; nausea and vomiting, P = .556; return to normal diet well, P = .234; return to normal activity, P = .668; bedtime, P = .056; number of times awake during the night, P = .593). There is no evidence of benefit from postoperative administration of corticosteroids in pediatric patients recovering from tonsillectomy.

Asymptomatic bilateral pulmonary embolism in Churg-Strauss syndrome

To the Editor: Churg–Strauss syndrome (CSS) is a systemic small-sized vessel vasculitis, characterised by severe asthma, transient pulmonary infiltrates, and blood and tissue eosinophilia [1]. CSS can affect several organs, including the lungs, heart, kidneys and peripheral nervous system. Anti-neutrophil cytoplasm autoantibodies (ANCA) mainly directed against myeloperoxidase (MPO) are detected in ∼40% of patients and are associated with renal involvement. Several studies have focused on venous thromboembolic events (VTE), which are an emerging clinical condition in ANCA-associated vasculitides (AAV) [2, 3]. Herein, we report the case of a patient with newly diagnosed CSS and totally asymptomatic pulmonary embolism, and discuss the features, pathogenesis and management of VTE in CSS. In February 2011, a 61-yr-old male was referred for recent asthenia, diffuse arthromyalgia and blood eosinophilia. His past medical history included high blood pressure treated with amlodipine. There were no other risk factors for VTE other than age and inflammatory state. His recent history included late-onset asthma, which started 1 yr earlier and required various combined inhaled corticosteroids, bronchodilators and several short courses of oral corticosteroids. In early December 2010, the patient complained of general weakness, weight loss and diffuse myalgia. In late December, another asthma flare-up was successfully treated with a course of oral prednisolone (1 mg·kg−1 per day for 5 days), which was effective for both myalgia and weakness. Unfortunately, muscle and joint pain immediately relapsed as soon as corticosteroids were discontinued, while respiratory symptoms had improved. In February 2011, a thoracic computed tomography (CT) scan was performed, focusing on the parenchyma not vessels. No lesions were reported. At the same time, distal paresthesia appeared and subsequently concerned the lower left and upper right limbs. Following this, the patient was referred to our department (Internal Medicine …

The role of steroids in children with multiple recurrences of intussusception

We describe the case of a boy who had 9 recurrences of intussusception, for which no pathological lesion at the leadpoint was identified. A contrast follow-through study revealed a follicular/nodular mucosal pattern, particularly prominent in the terminal ileum and caecum. Patients with multiple recurrences usually have an identifiable lesion at the leadpoint, but sometimes recurrences may be due to lymphoid hyperplasia, as presumed in our case. No further recurrences occurred after a two month tapering course of oral prednisolone.

Effects of a Short Course of Oral Prednisolone in Patients with Bladder Pain Syndrome with Fluctuating, Worsening Pain despite Low-Dose Triple Therapy

PurposeTriple therapy with gabapentin, amitriptyline, and nonsteroidal antiinflammatory drugs is efficacious for chronic bladder pain syndrome/interstitial cystitis (BPS/IC). However, transient, fluctuating, worsening pain or flare-up symptoms may develop during treatment for a variety of reasons. Here, we assessed the validity of our observational experience regarding a short course of oral prednisolone therapy, which might be of value in the management of flare-up symptoms of BPS/IC.MethodsBetween May 2007 and May 2012, 7 women (mean age, 61.5 years; range, 44.8 to 75.4 years) with BPS/IC presenting with transient, fluctuating, worsening pain as a flare-up symptom despite low-dose triple therapy received a 1- to 3-month course of oral prednisolone 10 mg. The outcome measures used were the IC symptom scale (ICSS, O'Leary-Sant Interstitial Cystitis Symptom Index) and a visual analogue scale (VAS), which were completed at baseline and after treatment.ResultsThere were statistically significant differences in the ICSS and VAS score before and after prednisolone treatment (P<0.05 by Wilcoxon singed-rank test). The pretreatment IC symptom index (ICSI), IC problem index (ICPI), and VAS score were 16.7± 2.2, 13.7±2.3, and 8.3±1.5 (mean±standard deviation [SD]), and the posttreatment scores were 4.9±2.3, 4.3±1.1, and 2.5±0.9 (mean±SD), respectively. The ICSI, ICPI, and VAS scores were improved after prednisolone treatment by 70.7%, 68.6%, and 69.9%, respectively. Low-dose triple therapy with prednisolone caused no significant adverse effects.ConclusionsIn patients with BPS/IC who show transient, fluctuating, worsening pain as flare-up symptoms despite undergoing low-dose triple therapy, a short course of oral prednisolone therapy was sufficiently effective. However, large-scale studies should be performed to verify our findings.

Allergic bronchopulmonary mycosis due to Alternaria: Case report and review

While allergic bronchopulmonary aspergillosis and mycosis are well recognised, no cases have been described related to Alternaria spp. Alternaria is a common sensitising fungus in asthmatics and related to thunderstorm asthma. We report a case of an asthmatic who presented with worsening asthma control, mild eosinophilia on high dose inhaled corticosteroids (800μg/day), a total IgE of 3800KIU/L, an Alternaria-specific IgE of 21.3KUa/L and positive skin prick test, negative specific IgE and skin prick test to Aspergillus fumigatus, Penicillium spp., Cladosporium spp., Trichophyton spp. and a normal CT scan of the thorax. He responded well to a short course of oral prednisolone and then oral itraconazole, given over 17 months but relapsed 1 month after stopping it.

Orbital Inflammation: A Rare Association of Common Variable Immunodeficiency

Purpose: Ocular associations with common variable immunodeficiency (CVID) are very rare which include granulomatous uveitis, mulitfocal choroiditis and retinal vasculitis. However there have been no reports of orbital involvement, either inflammatory or neoplastic in association with CVID. We describe a unique case of a patient with CVID who developed orbital inflammation.Methods: Clinical, histological and radiological findings and the management of this case is presented.Results: A 58 year old male with known CVID treated with regular intravenous immunoglobulin infusion, presented with left peri-orbital redness, pain, proptosis and restriction of ocular movements. CT scan showed an ill-defined mass in the left lateral orbit, adjacent to the lacrimal gland. An orbital biopsy revealed a monomorphic lymphocytic infiltrate forming loose lymphoid aggregates in the lacrimal gland tissue. Immunocytochemistry confirmed this to be a reactive inflammatory infiltrate. The patient was successfully treated with a course of oral prednisolone which resulted in improvement of orbital inflammation, ocular movements and proptosis.Conclusion: To our knowledge this is the first reported case of non-granulomatous orbital inflammation in association with CVID. This case serves to remind ophthalmologists encountering a patient with CVID that they may have associated orbital inflammatory disease which is responsive to steroid therapy similar to sterile inflammatory masses described in other organs.

Clinical efficacy of a short course of systemic steroids in nasal polyposis

Although oral steroids are widely used for the treatment of nasal polyposis, a subset of patients shows an unfavorable therapeutic outcome. The aim of this study was to evaluate the efficacy of a short course of oral prednisolone in nasal polyposis and to evaluate which, if any, clinical variables can predict treatment outcome in these patients. Using a 3:2 randomization ratio, 63 patients with nasal polyposis received 50 mg of prednisolone and 46 patients received placebo daily for 14 days. Clinical response was evaluated by total nasal symptoms score (TNSS), peak expiratory flow index (PEFI) and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test and sinus radiography. The prednisolone-treated group showed significantly greater improvements in all nasal symptoms, nasal flow and polyp size than the placebo-treated group (p < 0.001, all). In the prednisolone-treated group, patients with grade 3 polyps and positive nasal endoscopy showed significantly less improvement in TNSS, PEFI and TNPS than patients with grades 1-2 size and with negative nasal endoscopy. A short course of oral steroids showed good clinical efficacy in the treatment of nasal polyposis, however, polyps size grade 3 and/or positive nasal endoscopy predispose to a poorer treatment outcome.

Pulmonary lymphangitic carcinomatosis presenting as severe interstitial lung disease in a 15-year-old female

To the Editor: Pulmonary lymphangitic carcinomatosis (PLC) is a metastatic lung disease characterised by the diffuse infiltration and obstruction of the pulmonary parenchymal lymphatic system by tumour cells [1]. It is an extremely rare diagnosis in paediatrics and we believe that this is the first reported case in a child, presenting as interstitial lung disease without a known primary tumour. A 15-yr-old Caucasian female was transferred to our hospital (Birmingham Children's Hospital, Birmingham, UK) for further assessment and management of respiratory failure, secondary to presumed interstitial lung disease. 8 weeks previously she had presented to her local hospital with a 5-week history of cough and shortness of breath associated with lethargy, poor appetite and early satiety. On examination she was hypoxic with bilateral wheeze and crackles. Bilateral perihilar shadows and increased bronchovascular markings were seen on the chest radiograph. Atypical pneumonia was diagnosed and she received oxygen, oral erythromycin and inhaled salbutamol. She recovered but after discharge required two courses of oral prednisolone and salbutamol for wheeze and shortness of breath. She deteriorated while visiting relatives in the Birmingham area of the UK and required admission for cough, shortness of breath and haemoptysis. On examination she was tachypnoeic, tachycardic and hypoxic but not clubbed. There was generalised decreased air entry and bilateral inspiratory crackles on ausultation. Her blood tests were unremarkable apart from elevated C-reactive protein (54 mg·L−1). A chest radiograph and subsequent computed tomography (CT) scan of her chest showed extensive, bilateral interstitial changes (fig. 1). A diagnosis of presumed interstitial lung disease was made. The differential diagnoses are …

Neonatal Behçet’s disease without maternal history

A neonate presented with frequent vomiting since 10days old, followed by severe diarrhea. Multiple oral ulcers and recurrent genital ulcers subsequently appeared. Colonoscopy showed multiple shallow round ulcerations in the colon. The symptoms responded well to a short course of oral prednisolone. There was a brief recurrence of vomiting, diarrhea, and oral ulcers at 2months old. The mother has never had any symptoms of Behçet's disease to date. This is the first reported case in literature of neonatal Behçet's disease without a maternal history of Behçet's disease, which raises doubts about the assumed role of maternal antibodies in the pathogenesis of neonatal Behçet's disease. A literature review of neonatal Behçet's disease shows that oral ulcers, skin lesions, fever, and leukocytosis are common features. However, only half of the patients fulfill the classical diagnostic criteria based on adult studies. A treatment consensus for neonatal cases is also lacking.

Can 11β-Hydroxysteroid Dehydrogenase Activity Predict the Sensitivity of Bone to Therapeutic Glucocorticoids in Inflammatory Bowel Disease?

In healthy individuals measures of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme activity predict the change in bone formation markers in response to therapeutic glucocorticoids. It is unclear whether these measures remain predictive in inflammatory disease. We therefore examined whether 11β-HSD1 activity predicts changes in bone markers and bone mineral density (BMD) in patients with inflammatory bowel disease (IBD) treated with therapeutic glucocorticoids. Prospective and cross-sectional studies were carried out in patients attending a gastroenterology clinic with active (n=39) or clinically inactive (n=34) IBD and healthy controls (n=51). Urinary corticosteroid metabolite profiles were obtained on a spot urine sample and total corticosteroid metabolite excretion and 11β-HSD1 activity (measured as the ratio of tetrahydrocortisol to tetrahydrocortisone metabolites, [THF+alloTHF]/THE) determined. Patients with active disease were treated with an 8-week reducing course of oral prednisolone. The (THF+alloTHF)/THE ratio was significantly increased in patients with IBD, even those in clinical remission. The baseline (THF+alloTHF)/THE ratio failed to predict the decrease in bone formation markers or hip BMD. Measures of 11β-HSD activity do not predict bone loss during glucocorticoid treatment of active IBD, probably due to disease-related increases in 11β-HSD1 activity. Our observation of elevated 11β-HSD1 activity in clinically inactive IBD implicates gastrointestinal glucocorticoid activation in the maintenance of disease remission.

Cushing's syndrome and adrenal axis suppression in a patient treated with ritonavir and corticosteroid eye drops

Cushing's syndrome and adrenal axis suppression in a patient treated with ritonavir and corticosteroid eye drops

Ten cases of drug reaction with eosinophilia and systemic symptoms (DRESS) treated with pulsed intravenous methylprednisolone

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening, drug-induced illness characterised by a widespread polymorphic eruption, fever and multivisceral involvement. There is little published on the management of DRESS. Prompt recognition and withdrawal of the causative drug is essential, along with supportive treatment. However, the condition commonly progresses despite these measures. Oral corticosteroids are usually given but the response can be suboptimal and result in a prolonged exposure to systemic glucocorticoid. We conducted a prospective single-centre study to determine the efficacy of pulsed intravenous methylprednisolone followed by a short reducing course of oral prednisolone in ten patients with confirmed DRESS. Rash and fever responded rapidly to methylprednisolone in all patients. Compared to pre-treatment assessments, there was a significant reduction in eosinophil count at day 14 and AST level at day 90 post-treatment. One patient developed acute hepatic failure, necessitating a liver transplant, and died 4 months later. In the immediate post-treatment phase, 1 patient developed type 1 diabetes and 1 patient developed a corticosteroid-induced psychosis. Long-term follow-up on 8/10 revealed all patients to be well, although one patient had persistent pruritus. An aggressive corticosteroid regimen in the management of DRESS is associated with good clinical outcome and acceptable tolerance.

S137 The At-Risk Registers in Severe Asthma (ARRISA) Study: a cluster-randomised controlled trial in primary care

ObjectivesTo evaluate the effectiveness of using electronic registers to identify and improve management of high-risk asthma patients in primary care.DesignCluster-randomised controlled trial with stratification by high/low deprivation scores and 1-year...

255 Parent-Initiated Oral Prednisolone for Episodes of Acute Asthma in Children Aged 5-13 Years

Background: There is high-level evidence that oral corticosteroids are effective in the treatment of acute asthma in school-aged children when administered following physician review. However, existing data regarding the effectiveness of parent-initiated oral corticosteroids for acute asthma in children is both disappointing and inadequate. We therefore aimed to assess the efficacy of a short course of parent-initiated oral prednisolone for acute asthma in school-aged children. Methods: We used a population-based sampling strategy to recruit children aged 5-12 years who had suffered four or more episodes of acute asthma in the preceding year. Episodes of acute asthma (rather than participants) were randomised to be treated with a 3-5 day course of parent-initiated prednisolone (1mg/kg) or placebo. The primary outcomes were a 7-day daytime symptom score and health resource utilization (HRU). Results: 230 children were enrolled in the study. Over a 3 year period 131 participants contributed 155 episodes of acute asthma randomised to parent-initiated treatment with prednisolone and 153 episodes treated with placebo. The mean daytime symptom score was on average 15% (95% CI 2% to 26%, p=0.022) lower among episodes treated with prednisolone. Concordantly, 48 (31%) of episodes treated with prednisolone resulted in HRU compared with 69 (45%) of episodes treated with placebo (odds ratio = 0.54, 95% CI 0.34 to 0.86, p=0.010). Conclusions: We found that a short course of oral prednisolone initiated by parents when their child suffers an episode of acute asthma resulted in a modest reduction in asthma symptoms and HRU.

Continuous oral versus single pulse intravenous corticosteroid in the prevention of inflammation following cataract surgery in uveitis patients

Abstract Purpose To compare post‐operative inflammation and development of cystoid macular oedema (CMO) in uveitis patients undergoing cataract surgery and intraocular lens (IOL) implantation who had either pre‐operative oral or intra‐venous (IV) corticosteroid. Methods Retrospective case note study comparing uveitis patients undergoing phakoemulsification cataract surgery and implantation of an acrylic IOL (performed by one surgeon), having either oral corticosteroid (usually 40mg prednisolone two weeks prior to surgery and tapered by 5‐10mg weekly post‐operatively) or a single 500mg IV methylprednisolone pulse one hour prior to surgery. Results 30 procedures (35 patients) were identified where pre‐operative oral corticosteroid had been given, and 93 procedures (76 patients) where IV corticosteroid was given. In the oral corticosteroid cohort there were 2 (7%) episodes of fibrinous uveitis and 4 (13%) episodes of CMO within 90 days of the surgery. In the IV cohort there were 3 (3%) episodes of fibrinous uveitis and 16 (17%) episodes of CMO within 90 days of surgery. There was no statistically significant difference in the number of episodes of fibrinous uveitis or CMO between the two groups. Conclusion There was no difference in the incidence of post‐operative fibrinous uveitis or CMO in patients who were given either pre‐operative oral or IV corticosteroid. A single pulse of 500mg IV methylprednisolone appears a reasonable alternative to a course of oral prednisolone in uveitis patients undergoing cataract surgery.

Biopsy proven acute interstitial nephritis after treatment with moxifloxacin

BackgroundAcute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury. At least 70% of AIN is caused by various drugs, mainly penicillines and non-steroidal anti-inflammatory drugs. Quinolones are only rarely known to cause AIN and so far cases have been mainly described with older fluoroquinolones.Case PresentationHere we describe a case of biopsy proven interstitial nephritis after moxifloxacin treatment. The patient presented with fever, rigors and dialysis dependent acute kidney injury, just a few days after treatment of a respiratory tract infection with moxifloxacin. The renal biopsy revealed dense infiltrates mainly composed of eosinophils and severe interstitial edema. A course of oral prednisolone (1 mg/kg/day) was commenced and rapidly tapered to zero within three weeks. The renal function improved, and the patient was discharged with a creatinine of 107 μmol/l.ConclusionThis case illustrates that pharmacovigilance is important to early detect rare side effects, such as AIN, even in drugs with a favourable risk/benefit ratio such as moxifloxacin.

Circulating cytokines and procalcitonin in acute Q fever granulomatous hepatitis with poor response to antibiotic and short-course steroid therapy: a case report

BackgroundQ fever is a zoonosis distributed worldwide that is caused by Coxiella burnetii infection and the defervescence usually occurs within few days of appropriate antibiotic therapy. Whether the changes of cytokine levels are associated with acute Q fever with persistent fever despite antibiotic therapy had not been investigated before.Case PresentationWe report a rare case of acute Q fever granulomatous hepatitis remained pyrexia despite several antibiotic therapy and 6-day course of oral prednisolone. During the 18-month follow-up, the investigation of the serum cytokines profile and procalcitonin (PCT) revealed that initially elevated levels of interleukin-2 (IL-2), IL-8, IL-10, and PCT decreased gradually, but the IL-6 remained in low titer. No evidence of chronic Q fever was identified by examinations of serum antibodies against C. burnetii and echocardiography.ConclusionsThe changes of cytokine levels may be associated with acute Q fever with poor response to treatment and PCT may be an indicator for monitoring the response to treatment.

The Jones Morbidity Index as an aid for community pharmacists to identify poor asthma control during the dispensing process

Abstract Objective To determine if the Jones Morbidity Index can be used in community pharmacy when asthmatic patients collect their prescriptions to identify those who have poor control. Method Structured questionnaires were completed by asthmatics who presented prescriptions at community pharmacies to assess their morbidity and knowledge of asthma and their attitudes towards and usage of medication. Setting Community pharmacies throughout the UK. Key findings Complete data on 306 patients were returned by 41 community pharmacists. Seventy-one patients reported using an asthma diary, 161 attended an asthma clinic and 194 had visited their doctor during the past year because of an acute exacerbation (GPV). Problems with metered dose inhaler (MDI) technique were identified in 165 patients. Patients' mean (SD) asthma knowledge score (K) (maximum 5) was 3.48 (1.32). Over the past six months they had received 0.88 (1.78) courses of oral prednisolone (P), 1.12 (1.85) courses of antibiotics (A) and 1.20 (4.51) courses of cough medicine (CM). Using the Jones Morbidity Index (JMI), 74 patients (24.2%) had low morbidity, 90 (29.4%) had medium morbidity and 142 (46.4%) had high morbidity. Comparisons between the morbidity categories revealed significant differences for P, A, GPV, “happy with” preventer (P &amp;lt; 0.001) and “happy with” reliever (P &amp;lt; 0.01) together with CM, K and compliance (P &amp;lt; 0.05). More patients classed as having high morbidity overused their reliever (P &amp;lt; 0.01) and were less compliant with their preventer (P &amp;lt; 0.001). There was no association between JMI and medication. Conclusion The JMI is a valuable tool to identify poor asthma control when patients present prescriptions at community pharmacies. More than half the asthmatics presenting their prescriptions at pharmacies had symptoms and signs indicating poor control.

Toll-like Receptor Expression on Peripheral Blood Mononuclear Cells in Asthmatics; Implications for Asthma Management

Accumulating evidence indicates that cells expressing Toll-like receptors (TLRs) play an important role in allergic diseases. The authors undertook this study to explore the hypothesis that TLR-mediated inflammatory signals are important from the perspective of asthma management. The expressions of TLR1, TLR2, TLR3, TLR4, TLR6, and TLR9 and levels of pro-inflammatory cytokines (TNF-alpha, IL-1beta, IL-6, IL-8, and IFN-gamma) on the peripheral blood mononuclear cells (PBMCs) of 36 stable asthmatics on treatment (the on-treatment group), 15 asthmatics (the treatment-naïve group) before and after a 7-day course of oral prednisolone (30 mg/day), and on the PBMCs of 15 healthy controls were measured after in vitro stimulation using TLR-specific ligands. In the on-treatment group, TLR1, TLR2, TLR6, and TLR9 expressions on PBMCs were significantly different between asthmatics and controls. And the expression of TLR4 on PBMCs and TNF-alpha production stimulated by lipopolysaccharide (LPS), were significantly higher in mild to moderate than in severe asthmatics. Interestingly, in the treatment-naïve group, short-term prednisolone significantly increased LPS-induced TNF-alpha and IFN-gamma productions by PBMCs. TLR-mediated inflammatory signals contribute to the development and severity of asthma and are not reduced by glucocorticoid treatment, which suggests that a TLR-specific antagonist and glucocorticoid are required for the effective control of airway inflammation in asthmatics.