Corticosteroid Intake Research Articles

Domestic endotoxin exposure and clinical severity of asthma

Endotoxins are potent pro-inflammatory substances present in several natural environments and in commercial house dust extracts. To investigate the possible effect of chronic endotoxin exposure on asthma, 28 patients with perennial chronic asthma (20 allergic to house dust mite and eight intrinsic asthmatics) were evaluated during a 4-month period (lung function, clinical and immunological criteria). At the same time, two house dust samples were collected from each patient's home to determine total house dust weight (mg/m2), endotoxin concentration and house dust mite antigen content (evaluated indirectly by guanine content with HPLC method). The mean (+/- s.d.) endotoxin concentration, as measured by quantitative Limulus assay was 2.59 (+/- 3.41) ng/mg house dust, ranging from 0.12 to 20 ng/mg. The mean guanine content was 0.13 (+/- 0.16) mg/100 mg house dust. There was no correlation between endotoxin and house dust mite concentrations. Patients were compared according to the low or high grade exposure to dust, endotoxins and guanine. Compared with patients with low grade (less than or equal to 5.6 ng/ml) exposure, subjects exposed to high endotoxin concentrations (greater than 5.6 ng/ml) showed a significant increase in dyspnea (median 2.6 vs 3.3; P less than 0.05) and treatment (median 14 vs 44.3; P less than 0.01) scores, oral corticosteroid (median 0.0 vs 13.5 mg/24 hr; P less than 0.01) and beta 2-mimetics (median four vs eight puffs/day; P less than 0.01) intake, and a significant decrease in FEV1/FVC (median 84.5 vs 67% of predicted value; P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Elastic fibers in striae distensae.

Eight cases with striae distensae associated with obesity or prolonged corticosteroid intake were examined by light and scanning electron microscopy. Fine elastic fibers predominated in early lesions, while thick elastic fibers predominated in older lesions. In early lesions the periphery showed thick and tortuous elastic fibers, but in older lesions it was of normal appearance. It is suggested the elastic fibers in striae were newly synthesized and gradually increased and thickened with age.

Aspirin intolerance and asthmal induction of a tolerance and long‐term monitoring

Acetylsalicylic-acid (ASA) intolerance is well recognized as a possible cause for exacerbating asthma. It has been postulated that if this could be overcome, long-term aspirin administration could improve asthma symptoms and enable reduction of the use of other anti-asthmatic drugs. We succeeded in inducing an ASA tolerance in nine corticosteroid-dependent asthmatics, and this tolerance lasted at least 1 month and at most 1 year. Progressive deterioration in lung function was seen, however, in all patients taking ASA for more than 1 month, unless the corticosteroid intake was increased. These results suggest that ASA long-term treatment is of no help to severe corticosteroid-dependent, ASA-sensitive asthmatics. This conclusion differs from other reports on ASA intolerance in asthma.

Respiratory disease in tea workers in Sri Lanka.

Blending of different grades of tea is a very dusty process which exposes workers to a fine fluff. One hundred and twenty-five tea blenders with an average service of 22.9 years in the industry were interviewed according to a standard questionnaire, and submitted to a clinical and radiographical examination. The examination was repeated eight and 31 months later. A total of 46 workers (36%) had respiratory illness, 31 had chronic bronchitis (24.8%), eight had asthma (6.4%), and seven had active or inactive pulmonary tuberculosis (5.6%). The prevalence of chronic bronchitis and asthma was more than that expected in the general population. It is suggested that these two conditions are aetiologically related to long-term exposure to tea fluff.

Chronic pulmonary catarrh and fibrosis in school children.

The association of bronchiectasis (BE) in patients with severe eosinophilic asthma (SEA) is quite frequent. Mepolizumab is a well-recognized treatment for SEA; we aim to evaluate its effectiveness in SEA patients with and without BE in real-life.We performed a single-center retrospective pilot study, including patients with SEA treated with mepolizumab for one year. Asthma control test (ACT), lung function, annual exacerbations rate, oral corticosteroid dosage, FeNO, chronic mucous secretions, blood and sputum eosinophils were recorded at baseline and after 6 and 12 months.Results: we included 32 patients (mean age: 52.3 ± 10, 59% female). 50% showed co-presence of bronchiectasis, (SEA + BE). Significant improvements were found in ACT [(13.8 ± 4.6 to 20.7 ± 4.1, p = 0.0009) and (13 ± 4.8 to 20.7 ± 4.6, p = 0.0003)], annual exacerbations rate [from 7 (4–12) to 0 (0.00–0.75) and from 8 (4–12) to 0 (0–1), p < 0.0001], and blood eosinophils count [748 cells/μL (400–1250) vs. 84 cells/μL (52.5–100), and from 691 cells/μL (405–798) vs. 60 cells/μL (41–105), p < 0.0001] in SEA and SEA + BE group respectively, already after 6 months of treatment. A reduction in daily oral corticosteroids intake at 12 months was shown [from 15 mg (0–25) to 0 mg (0-0), p = 0.003 and from 8.8 mg (0–25) to 0 mg (0-0) (p = 0.01)] in both SEA and SEA + BE, respectively. Similar results were found, comparing SEA + BE patients based on the severity of bronchiectasis.Mepolizumab effectively improves asthma symptoms control, reducing annual exacerbations and corticosteroid intake in all patients with SEA, even in the subgroup with coexisting bronchiectasis, independently of their severity.