Abstract The following are the structural changes in cases of asthma that are related to long-term, high-dose corticosteroid therapy: (1) an external appearance of Cushing's disease, (2) a decrease in the inflammatory reaction, mucus gland activity, basement membrane prominence, and smooth muscle hypertrophy of the bronchial and bronchiolar walls, (3) a hypertrophy of the myocardial fibers, (4) an atrophy of the zona fasciculata of the adrenal cortices, (5) a cytoplasmic hyalinization and vacuolization of pituitary basophils and a hyperplasia of pituitary acidophils, (6) an atrophy of the lymphatic tissue of the spleen, and (7) a slight and infrequent osteoporosis (Table I). Long-term, high-dose corticosteroid therapy for asthma that begins after 40 years of age and is continuous is justified. The favorable antiinflammatory effect of corticosteroids on the bronchi and bronchioles probably accounts for the extended longevity. The other structural tissue alterations related to corticosteroids seem to be lesser evils when one is confronted with the consequences of this type of asthma.
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