Regular Corticosteroid Use Research Articles

Development and validation of QDiabetes-2018 risk prediction algorithm to estimate future risk of type 2 diabetes: cohort study

Objectives To derive and validate updated QDiabetes-2018 prediction algorithms to estimate the 10 year risk of type 2 diabetes in men and women, taking account of potential new risk factors,...

Study on Corticosteroids use Pattern in Dermatological Practice and Investigating Adverse Effect of Corticosteroids Including its Associated Factors

Background Corticosteroids are highly effective drugs with anti-inflammatory and immunosuppressive properties. Due to this, they have become a mainstay of pharmacotherapy in dermatology. However, improper and long term uses are associated with a number of serious adverse effects. Objective To investigate the corticosteroids use pattern, adverse effects and various factors associated with adverse effects in dermatological practice. Method A cross-sectional study was conducted in a dermatology department of tertiary care hospital. All patients using at least one corticosteroids, either topically or systemically or the combination were included in this study. Informed consent was taken from the patients and interviewed using structured questionnaire. Statistical analysis was performed by using SPSS 20. p-value < 0.05 was considered as statistically significant. Result Among the 60 participants under this study, 81.67% of them were females. The mean (±SD) age of the patients was 31.03 years (±15.0). A majority (58.30%) of the patients was prescribed with topical corticosteroids with low potency (25%). Most of them had used corticosteroids for urticaria. Adverse effects were reported by 33.30% of the patients. The most common adverse effect reported was the shedding of skin. Adverse effects was significantly associated with gender; use of systemic corticosteroids; regular use of corticosteroids; discontinuation of dose abruptly; and missed dose. However, there was no significant association between adverse effects and the duration of use of corticosteroids. Conclusion In conclusion, the present study suggested that the proper counselling and clear instruction regarding the use of corticosteroid should be provided to the patients for avoiding the abrupt discontinuation of the prescribed medication leading to treatment failure.

Regular Use of Corticosteroids and Low Use of Short-Acting β2-Agonists Can Reduce Asthma Hospitalization

Inhaled corticosteroids (ICS) and inhaled short-acting beta(2)-agonists (ISABA) are the most commonly used medications for management of asthma. Increased asthma morbidity and mortality have been reported with excess use of ISABA in several studies. In these studies, authors have used different indicators to control for the potential confounding by asthma severity. The objective of this study was to determine the effect of ICS use on the association between use of ISABA and first hospitalization for asthma after controlling for several indicators of asthma severity.An inceptional cohort study using Saskatchewan Health databases.The Province of Saskatchewan, Canada.A total of 29,957 persons aged 5 to 54 years who had at least five asthma-related visits to physicians between 1991 and 2000.Among the subjects with increased asthma severity, indicated by one or more average number of asthma-related physician visits per 3 months during the follow-up, high use of ISABA was a risk factor for hospitalization when no ICS were used (rate ratio [RR], 2.16; 95% confidence interval [CI], 1.51 to 2.95). There was a beneficial effect of ISABA when there was low use of ICS (RR, 0.65; 95% CI, 0.42 to 0.93) or high use of ICS (RR, 0.23; 95% CI, 0.12 to 0.41). Among the subjects with less severe asthma, indicated by less than one asthma-related physician visits per 3 months, on average, during the follow-up, the risk of hospitalization was even greater for high use of ISABA when no ICS were used (RR, 10.06; 95% CI, 6.99 to 14.47). This was reduced but not abolished when there was low use of ICS (RR, 3.24; 95% CI, 2.29 to 4.59) and negated altogether by high use of ICS (RR, 1.10; 95% CI, 0.39 to 3.12).Among both severe and less severe asthma groups, high use of ISABA was associated with an increased risk of asthma hospitalization in the absence of any use of ICS, which was progressively reduced with low and high use of ICS. This finding was independent of asthma severity and could result from lack of control through over reliance on ISABA in asthma management.

Asthma hospitalisation prevented with regular corticosteroid use

Asthma hospitalisation prevented with regular corticosteroid use

A Prospective, Open-Label Trial Assessing Dexamethasone Pulse Therapy in Moderate to Severe Ulcerative Colitis

Severe ulcerative colitis is conventionally treated with parenteral corticosteroids followed by oral corticosteroids. Regular use of corticosteroids is associated with side effects. Corticosteroid pulse therapy, i.e., use of supraphysiologic dose followed by complete withdrawal, which is likely to have fewer side effects, was tried in the current study. Dexamethasone pulse therapy, i.e., 100-mg/d infusion in 5% dextrose, was used for 3 consecutive days in 14 patients with severe ulcerative colitis. Ulcerative colitis disease activity was assessed on days 7, 15, 30, and 60. The primary end point was defined as the number of patients who achieved clinical remission and an activity index less than 150 at day 15. The second end point was the number of patients who remained in remission and had an activity index less than 150 at 30 and 60 days. None of the patients enrolled got subsequent oral corticosteroids after their 3 days of megadose corticosteroid infusion. Clinical remission was achieved in 93% patients (13 of 14 patients) by day 15. Two of these 13 patients suffered relapse during follow-up, and hence, the clinical remission was sustained in 79% patients at 30 and 60 days. Dexamethasone pulse therapy is highly effective in inducing remission in patients with ulcerative colitis, but randomized controlled trials are needed to compare dexamethasone pulse therapy with standard oral continuous corticosteroid regimens.

A South Australian population survey of the ownership of asthma action plans.

To examine the relationships between ownership of written asthma action plans, asthma morbidity, use of devices, and patients' perceptions of their asthma management. A random population survey (in 1996) of the South Australian population aged 15 years or over, using interviewers to administer a questionnaire. People who reported that they had current, doctor-diagnosed asthma. Prevalence of written asthma action plans; night-time awakenings from asthma; ownership of peak flow meters; and people's perceptions of their asthma management. The ownership of asthma action plans by people with self-reported asthma was 33% and has declined since 1995 (42%; P < 0.001). Fifteen per cent were awakened weekly or more frequently by asthma symptoms. These people were more likely to have a peak flow meter and a written action plan, but less likely to consider they had been provided with enough information about their asthma, to feel comfortable managing their asthma, or to find it easy to see their doctor. Having a written asthma action plan was associated with regular corticosteroid use, understanding asthma, having enough information and owning a peak flow meter. Ownership of asthma action plans in South Australia is suboptimal. Before we develop new strategies to improve asthma outcomes, we must determine whether there is a need to target people with less severe asthma and/or improve the use of guidelines by health professionals.

The complementary role of glucocorticosteroids and long-acting beta-adrenergic agonists.

In summary, beta 2-adrenergic agonists and corticosteroids can interact to produce beneficial effects on airway function. The regular use of short-acting, beta 2-adrenergic agonists as relief therapy is safe and effective; however, some degree of caution may be required with the use of very high doses. Long-acting beta 2-adrenergic agonists provide further benefits in terms of asthma control in patients already established on inhaled corticosteroid therapy. The mechanism by which this interaction occurs remains to be elucidated, but may involve a protective effect of corticosteroids on dysfunctional beta-adrenergic receptor expression and function. In asthma, there may be a degree of uncoupling of the airway receptors, probably caused by cytokines such as IL-1 beta. However, this has not been established yet. Furthermore, beta-adrenergic receptor-mediated effects may be more quickly downregulated with beta-receptor stimulation, leading to a reduction in anti-inflammatory effects. The regular use of corticosteroids leads to an inhibition of cytokine production and prevents beta-adrenergic receptor downregulation, allowing beta 2-adrenergic agonists to be more effective. Further research, which may lead to a greater understanding of these mechanisms, may also lead to the development of more effective treatment regimens.

Incidence of bronchoconstriction due to aspirin, azo dyes, non-azo dyes, and preservatives in a population of perennial asthmatics

Forty-five patients with moderately severe perennial bronchial asthma were challenged by ingestion of: acetylsalicylic acid (ASA); 4 azo dyes (tartrazine, sunset yellow, amaranth, and ponceau); 3 non-azo dyes (erythrosine, brilliant blue, and indigotin); sodium benzoate (NaB): parahydroxybenzoic acid (OHBA); butylated hydroxyanisole (BHA); and butylated hydroxytoluene (BHT). A fall in forced expiratory volume in one second (FEV 1) greater than 25% from baseline was considered positive. Seven patients who gave an unequivocal history of aspirin intolerance were not challenged with ASA; an additional 13 had positive open challenges to ASA, giving an apparent incidence of aspirin sensitivity of 20 45 . The presence of nasal polyps, sinusitis, or the regular use of corticosteroids, either singly or in combination, was not associated with an increased incidence of reactions to ASA. Significant bronchoconstriction to open challenges with agents other than ASA was less frequent. Positive open challenges to all substances except aspirin were followed by double-blind challenges which were positive in only 3 instances: 1 each with erythrosine, ponceau, and NaB OHBA . Our findings confirm that ASA intolerance is relatively common but suggest on the other hand that reactions to dyes and preservatives are an uncommon cause of clinically significant bronchoconstriction in moderately severe perennial asthmatics.

PIGMENTATION IN ALOPECIA TOTALIS

To the Editor : I have been treating many patients who have been afflicted with alopecia areata, totalis, and universalis. The method of therapy previously described by me (Alopecia Areata, Partialis, and Totalis: Treatment with Cortisone, Hydrocortisone, and Their Analogs, Prednisone and Prednisolone, Medical Times , October, 1956) is the cautious and regular use of corticosteroids, commencing with cortisone and hydrocortisone, and more recently the use of prednisone, prednisolone, and methyl prednisolone (Medrol). I have been supplementing the above therapy with weekly and subsequently biweekly injections of zinc corticotropin, which is given simultaneously to prevent the suppression of adrenal gland activity. I have observed that in a large majority of alopecia totalis patients there is a pallor and deficiency of normal pigmentation of the scalp and face. As the corticosteroid-corticotropin therapy continues, the growth of scalp hair is accompanied by gradual return of pigment to the face, scalp, and new hair,