Role Of Oral Corticosteroids Research Articles

Role of oral corticosteroids in the treatment of acute preschool wheeze.

Role of oral corticosteroids in the treatment of acute preschool wheeze.

Long-Term Weight Changes After Starting Anti-IL-5/5Ra Biologics in Severe Asthma: The Role of Oral Corticosteroids.

Many patients with severe asthma are overweight or obese, often attributed to unintentional weight gain as a side effect of oral corticosteroids (OCSs). Anti-IL-5/5Ra biologics significantly reduce OCS use, but their long-term effects on weight are unknown. To examine (1) weight change up to 2 years after anti-IL-5/5Ra initiation in subgroups on the basis of maintenance OCS use at start of treatment and (2) whether cumulative OCS exposure before or changes in OCS exposure during treatment are related to weight change. Real-world data on weight and cumulative OCS dose from adults included in the Dutch Registry of Adult Patients with Severe asthma for Optimal DIsease management before and at least 2 years after starting anti-IL-5/5Ra were analyzed using linear mixed models and linear regression analyses. For the included 389 patients (55% female; mean body mass index, 28 ± 5 kg/m2; 58% maintenance OCS), mean weight decreased-0.27 kg/y (95% CI,-0.51 to-0.03; P= .03), with more weight loss in patients with maintenance OCS use than in those without maintenance OCS use (-0.87 kg/y [95% CI,-1.21 to-0.52; P < .001] vs+0.54 kg/y [0.26 to 0.82; P < .001]). Greater weight loss at 2 years was associated with higher cumulative OCS dose in the 2 years before anti-IL-5/5Ra initiation (β=-0.24 kg/g; 95% CI,-0.38 to-0.10; P < .001) and, independently, greater reduction in cumulative OCS dose during follow-up (β= 0.27 kg/g; 95% CI, 0.11 to 0.43; P < .001). Anti-IL-5/5Ra therapy is associated with long-term weight reduction, especially in patients with higher OCS exposure before treatment and those able to reduce OCS use during treatment. However, the effect is small and does not apply to all patients, and so additional interventions seem necessary if weight change is desired.

Role of oral corticosteroids, methotrexate, and azathioprine in patients with unstable vitiligo

Background: There are several medical and surgical interventions for vitiligo but still the search for a definite cure is going on. The first goal of the therapy is to make the disease stable by preventing the appearance of new lesions. Drugs like oral corticosteroids, methotrexate, and azathioprine have been found effective in this phase. Objective: To compare the efficacy of oral corticosteroids, methotrexate, and azathioprine in patients with unstable vitiligo. Materials and Methods: It was a retrospective data analysis of 319 vitiligo patients, out of which 52 patients with unstable vitiligo who have received treatment in the form of 0.5 mg/kg oral corticosteroids on 2 consecutive days per week, 0.3 mg/kg methotrexate per week, and 1 to 1.5 mg/kg azathioprine daily were selected and were evaluated for the effect of drug for 12weeks. Results: There was no statistically significant difference in the appearance of new lesions in all 3 groups; however, methotrexate showed the early effect which plateaus after a few weeks whereas steroids as well as azathioprine showed a gradual and consistent effect. Conclusion: Methotrexate, steroids, and azathioprine all arrest the disease activity in vitiligo. Methotrexate can be used to arrest disease activity in fast-spreading vitiligo. Azathioprine can be used in patients with active vitiligo, wherever steroids are contraindicated.

Role of Oral Corticosteroids in Treatment of Home Isolated COVID-19 Patients

Role of Oral Corticosteroids in Treatment of Home Isolated COVID-19 Patients

Management of Preschool Children with Recurrent Wheezing: Lessons from the NHLBI's Asthma Research Networks

Recurrent wheezing in the preschool children is a common clinical problem, often associated with significant morbidity related to acute episodes. The management of these children has been complicated by a paucity of high-quality clinical trials in this age group. To fill this knowledge gap, National Heart, Lung,and Blood Institute's asthma research networks have performed a series of clinical trials in an effort to provide practitioners with guidance on appropriate management strategies. These studies establish daily inhaled corticosteroid (ICS) therapy in toddlers at high risk for subsequent asthma as an effective approach for the prevention of exacerbations and symptom reduction, but without evidence of disease-modifying properties. Additional studies have confirmed substantial heterogeneity in ICS response, in terms of both efficacy and effect on linear growth.Treatment with intermittent high-dose ICS was demonstrated to be an alternative approach to daily low-dose ICS for preventingsevere exacerbations in toddlers with intermittent butsignificant wheeze and a positive modified asthma predictive index. This review details the findings and clinical implications derived fromthese studies, discuss the utility of biomarkers andthe roleof oral corticosteroids during acute exacerbations, and summarizes ongoing clinical trials in this age group.

Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute ischemic optic neuropathy. The condition typically affects middle-aged and elderly individuals, though it may occur in younger age groups. Recent evidence suggests that its prevalence is higher than previously estimated. The clinical presentation of NAION is very classic and includes acute loss of visual afferent function (acuity, field and/or color) with the funduscopic appearance of an edematous optic nerve. The unaffected fellow eye usually has a small, crowded appearance described as a ‘disc at risk’. The pathophysiology of NAION is believed to be multi-factorial with the common pathway being circulatory insufficiency of the small caliber vessels supplying the optic nerve head. However, the exact location and mechanism of ischemia are still under debate. Prognosis of NAION is guarded; up to 50% of patients may have acuity of 20/200 or less with significant visual field loss, though approximately 40% will have improvement in their acuity. There are currently two animal models employed in investigating the histopathologic, molecular, and electrophysiologic changes seen in NAION. Treatment of the condition is quite controversial. Numerous medical and surgical interventions have been tried without clear evidence of benefit. The Ischemic Optic Neuropathy Decompression Trial demonstrated no benefit of optic nerve sheath fenestration in acute NAION. The role of oral corticosteroids is unclear, as is the use of aspirin in the prevention of the condition in the fellow eye. Several other promising agents are currently under investigation for the treatment of acute NAION.

Update in paediatric asthma management: Where is evidence challenging current practice?

Extrapolation of management strategies based on results from predominantly adult asthma studies frequently occurs in paediatric asthma despite increasing evidence that paediatric asthma and, in particular, pre-school recurrent wheeze are very different disease entities. Response to medications in paediatric subjects is often different from that seen in their older adolescent and adult counterparts. In this update, we discussed recent studies that have had important implications for future paediatric asthma management. The overuse of combination inhaled steroid and long-acting beta2 agonist inhalers in paediatric asthma despite ongoing safety concerns is an increasing trend in paediatric asthma, and recent evidence has helped clarify how they should be used in children. Other aspects discussed include the role of oral corticosteroids in pre-school viral-induced wheeze and the utility of leukotriene receptor antagonists in exercise-induced asthma.

319 Relapsing Membranous Nephropathy (MN) with Acute Kidney Injury (AKI) Following Influenza Vaccine: Role of Oral Corticosteroids

319 Relapsing Membranous Nephropathy (MN) with Acute Kidney Injury (AKI) Following Influenza Vaccine: Role of Oral Corticosteroids

Should Preschool Wheezers Ever Be Treated with Inhaled Corticosteroids?

The syndrome of preschool wheeze commonly regresses completely in the preschool years, but it may lead to prolonged symptoms and established asthma. Although epidemiological studies have established that there are several different phenotypes, it is currently impossible to assign the majority of wheezing preschool children to a phenotype prospectively. Bronchoalveolar lavage studies have shown an increase in total cellular inflammation in the youngest, symptomatic children, and that in older preschool children the neutrophil is the predominant inflammatory cell in the airway. Endobronchial biopsy studies have shown that eosinophilic inflammation and structural airway wall changes are absent in symptomatic infants but appear in severe wheezers by the age of 3 years. Treatment guidelines are not evidence based in this age group and frequently do not appear to consider either the likely pathology or the different patterns of symptoms. Pure virus-associated symptoms may be treated with intermittent beta-2 agonist or anticholinergics by inhalation. If this fails, intermittent oral leukotriene receptor antagonists or short courses of very high dose inhaled corticosteroids could be considered. The role of oral corticosteroids is highly debatable in young children with virus-associated wheeze. Prophylactic therapy may be considered for chronic intermittent symptoms (interval symptoms between acute episodes). The choices are oral leukotriene receptor antagonists, or inhaled corticosteroids, which should be introduced in a three-stage protocol to avoid overtreating the child with evanescent symptoms. Because the natural history of preschool wheeze is one of improvement, treatment should be tapered after a period of stability. Unfortunately, neither corticosteroids nor any other currently available therapy modifies the long-term outcome of preschool wheeze. In conclusion, corticosteroid treatment may have a small role in preschool wheeze, in particular for those thought to have early asthma, but the uncritical application of recommendations that are appropriate for older children and adults with asthma has led to widespread overuse of these medications. There is an urgent need for better treatment of preschool wheeze.

The effect of inhaled corticosteroids on bronchoalveolar lavage cells and IL-8 levels in stable COPD patients

Chronic obstructive pulmonary disease (COPD) is characterised by a chronic inflammatory process in the large and small airways, as well as in the lung parenchyma. Although the role of oral corticosteroids in the management of acute exacerbations of COPD is well documented, its role in stable COPD is not clear. We examined the anti-inflammatory effect of inhaled budesonide on the percentage of neutrophils and on interleukin-8 (IL-8) levels in bronchoalveolar lavage (BAL) and their correlation with spirometry and symptom scores. Twenty-six patients with stable COPD were randomised, in a double-blinded, placebo-controlled trial with either 800 microg of inhaled budesonide or placebo for a 6-month period. The budesonide-treated subjects had significant reductions in IL-8 levels in the BAL after therapy (mean+/-sem, 1.53+/-0.72 at baseline vs. 0.70+/-0.48 ng/ml at 6 months, P=0.004) and a reduction in the mean percentages of neutrophils (17.16+/-2.67% vs. 13.25+/-2.28% P=0.002). The improvement in sputum production was of borderline (P=0.058) significance but there was no improvement in lung function. In stable patients with COPD, treatment with inhaled budesonide for a period of 6 months has a positive effect on markers of lung inflammation, as assessed by reduction in percentage neutrophils and IL-8 concentration in BAL.

Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial

The role of oral corticosteroids in treating patients with exacerbations of chronic obstructive pulmonary disease (COPD) remains contentious. We assessed in a prospective, randomised, double-blind, placebo-controlled trial the effects of oral corticosteroid therapy in patients with exacerbations of COPD requiring hospital admission. We recruited patients with non-acidotic exacerbations of COPD who were randomly assigned oral prednisolone 30 mg once daily (n=29) or identical placebo (n=27) for 14 days, in addition to standard treatment with nebulised bronchodilators, antibiotics, and oxygen. We did spirometry and recorded symptom scores daily in inpatients. Time to discharge and withdrawals were noted in each group. We recalled patients at 6 weeks to repeat spirometry and collect data on subsequent exacerbations and treatment. Hospital stay was analysed by intention to treat and forced expiratory volume in 1 s (FEV1) according to protocol. FEV1 after bronchodilation increased more rapidly and to a greater extent in the corticosteroid-treated group: percentage predicted FEV1 after bronchodilation rose from 25.7% (95% CI 21.0-30.4) to 32.2% (27.3-27.1) in the placebo group (p<0.0001) compared with 28.2% (23.5-32.9) to 41.5% (35.8-47.2) in the corticosteroid-treated group (p<0.0001). Up to day 5 of hospital stay, FEV1 after bronchodilation increased by 90 mL daily (50.8-129.2) and by 30 mL daily (10.4-49.6) in the placebo group (p=0.039). Hospital stays were shorter in the corticosteroid-treated group. Groups did not differ at 6-week follow-up. These data provide evidence to support the current practice of prescribing low-dose oral corticosteroids to all patients with non-acidotic exacerbations of COPD requiring hospital admission.