Side Effects Of Oral Corticosteroids Research Articles

Family Physicians’ Awareness of the Burden of Oral Corticosteroids in Asthma Patients

Objective. The objective of this study was to identify when family physicians decide to prescribe oral corticosteroids (OCS) to treat asthma, to establish the factors affecting their decision, and how familiar family physicians are with the side effects of OCS. Materials and Methods. A cross-sectional observational study was conducted among physicians that are members of the Slovenian Family Medicine Society. Results. The study included 122 family physicians from all 12 Slovenian regions. The great majority (86.9%) reported they had previously prescribed OCS to asthma patients. The largest share of these (45.1%) tended to prescribe a limited number of tablets, although many (42.6%) also prescribed the entire pack. Regarding the adverse effects associated with OCS, the physicians listed a range of potential problems, highlighting hyperglycemia and exacerbated diabetes, the impact on bone density, a suppressed immune system and increased risk of infection as the most common. Conclusion. In the future, it is vital to improve family physicians’ awareness of when OCS may be prescribed to treat severe asthma, and to define the clinical pathway for severe asthma, which should also involve interdisciplinary collaboration.

Oral Corticosteroids versus Exercises on Treatment of Frozen Shoulder: A randomized, Single-blinded study.

Many treatment strategies have been described for the management of frozen shoulder. However, to date no randomized controlled trial has directly compared the efficacy of exercise and oral corticosteroids. The aim of this study was to determine whether pain, range of motion, and function differ between patients with frozen shoulder randomized to treatment with exercise or oral corticosteroids. This prospective, randomized, assessor-blinded trial was performed to compare the effectiveness of exercise and oral corticosteroids in patients with frozen shoulder. Overall, 33 patients with FS were randomly assigned to receive either exercise (n=17) or oral corticosteroids (n = 16). The exercise was applied 2 times per week for 6 weeks for 12 visits and patients in oral corticosteroids group received prednisolone for 4 weeks. Participants were assessed at baseline, after 6-weeks and at the 12-week follow-up. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS). The secondary outcomes were American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), range of motion, and hospital anxiety and depression (HAD). scale. Repeated-measures analysis of covariance (ANCOVAs) with baseline scores as the covariates were used to determine between-group differences. An intention-to-treat analysis was performed using the multiple imputation method to impute values for all missing data. Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups at the 6- and 12-week follow-ups compared to baseline. There were no significant time-by-group interactions between-group differences noted for the DASH (F=0.470, p= 0.93), VAS (F=0.006, p=0.94), flexion range of motion (ROM) (F=2.78, p=0.1), internal rotation ROM (F=3.440, p=0.07) and ASES (F=0.470, p=0.49). The overall group-by-time interaction for the 2×3 mixed-model ANCOVA using baseline scores as a covariate was significant for the abduction range (F=4.460, p=0.04) and external rotation range of motion (F=12.100, p = 0.002) in favor of the exercise group CONCLUSIONS: The study demonstrated that while both groups achieved significant improvements at the 6-, and 12-week follow-ups, the exercise group was superior in terms of abduction and external rotation range of motion. Additionally, even though both groups were improved, the effect sizes were larger in the exercise group. Considering the systemic side effects of oral corticosteroids, even at low doses, a well-planned exercise program that considers pain may be a good option for frozen shoulder.

Effet de la corticothérapie orale au long cours chez les patients asthmatiques sévères de type T2: Effect of long-term oral corticosteroid therapy in severe T2-weighted asthma patients

Severe asthma is defined by a disease that remains partially controlled, or even uncontrolled, despite high dose of inhaled corticosteroid (ICS), while the management of comorbidities and other precipitating or aggravating factors has been optimized. Severe asthma represents only 5% of the asthma population but significant economic burden is associated with the disease and represents 60% of healthcare costs. Corticosteroids have completely revolutionized the management of asthma, confirming the inflammatory nature of this disease. Identification of corticosteroids biological mechanisms in asthma allows to define type 2 inflammation, the inflammatory mediators (IL-4, IL-5, IL-13, TSLP, IL-33, IgE) and the non-invasive biomarkers (sputum and/or blood eosinophilia and/or tissue inflammation, FeNO, clinical and biological allergy, nasal polyposis, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) intolerance, corticosteroid dependent asthma). At least 60 to 80% of asthmatic patients have T2 inflammatory profile.Options to achieve oral corticosteroid-sparing (OCS-sparing) have been increasing interest because of the side effects of oral corticosteroids (OCS), and this has now become achievable with biologics. In addition, a crucial message is that the need for OSCs above 0.5 to 1 g/year exposes to major complications and indicates the need for referral to secondary/tertiary care.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Severe refractory asthma: current treatment options and ongoing research.

Patients with severe asthma have a greater risk of asthma-related symptoms, morbidities, and exacerbations. Moreover, healthcare costs of patients with severe refractory asthma are at least 80% higher than those with stable asthma, mainly because of a higher use of healthcare resources and chronic side effects of oral corticosteroids (OCS). The advent of new promising biologicals provides a unique therapeutic option that could achieve asthma control without OCS. However, the increasing number of available molecules poses a new challenge: the identification and selection of the most appropriate treatment. Thanks to a better understanding of the basic mechanisms of the disease and the use of predictive biomarkers, especially regarding the Th2-high endotype, it is now easier than before to tailor therapy and guide clinicians toward the most suitable therapeutic choice, thus reducing the number of uncontrolled patients and therapeutic failures. In this review, we will discuss the different biological options available for the treatment of severe refractory asthma, their mechanism of action, and the overlapping aspects of their usage in clinical practice. The availability of new molecules, specific for different molecular targets, is a key topic, especially when considering that the same targets are sometimes part of the same phenotype. The aim of this review is to help clarify these doubts, which may facilitate the clinical decision-making process and the achievement of the best possible outcomes.

"I have lost in every facet of my life": the hidden burden of severe asthma.

People with severe asthma are thought to face a sizeable daily disease burden. This study aimed to explore the little-known life experiences of people living with severe asthma.Adults with severe asthma were invited for telephone interview. Semistructured interviews were conducted until no new themes emerged. The 25 interviews were recorded, transcribed and analysed thematically.Four themes emerged. 1) "The body as a hindrance": severe asthma placed broad limits on life from daily chores to career, relationships and family life that left interviewees feeling emotionally distressed. 2) "Burden of treatment": participants mostly accepted the need to take treatment, but were particularly concerned about side-effects of oral corticosteroids. 3) "Alone with asthma": interviewees felt misunderstood and alone in their experience of breathlessness and frightening exacerbations; practical and emotional support needs were often lacking and the emotional distress of severe asthma was amplified in those with little support. 4) "Striving to adapt": patients used both positive strategies (acquiring self-management skills) and less positive strategies (avoidance of physical exertion) in the process of adjustment to living with severe asthma.Severe asthma imposes long-term, debilitating burdens and should be considered differently to milder disease. There is an urgent need to improve practical and emotional support services for patients and their carers.

Oral Corticosteroid Use and the Risk of Acute Myocardial Infarction in Chronic Obstructive Pulmonary Disease

Given the limited efficacy of oral corticosteroids in treating chronic obstructive pulmonary disease (COPD), the possible cardiac side effects of oral corticosteroids are of particular concern in an elderly population. The impact of the use of oral corticosteroids on the risk of acute myocardial infarction (AMI) in a cohort of patients with COPD was studied. The Saskatchewan health services databases were used to form a population-based cohort of 5648 patients aged 55 years or older who received a first treatment for COPD between 1990 and 1997. A nested case-control analysis was conducted: 371 cases presenting with a first myocardial infarction were matched with 1864 controls according to the length of follow-up, the date of cohort entry and age. Conditional logistic regression was used to adjust for sex, severity of COPD, systemic hypertension, diabetes and prior cardiovascular disease. Only the current use of corticosteroids was associated with an increased risk of AMI (adjusted RR=2.01 [95% CI 1.13 to 3.58]), particularly when the current dose was larger than 25 mg/day of prednisone or the equivalent (adjusted RR=3.22 [95% CI 1.42 to 7.34]). This observed increase in risk rapidly returned to baseline after the cessation of the medication, suggesting that the use of such high doses reflected the treatment of acute exacerbations of the disease. An association was found between the current use of oral corticosteroids and the occurrence of an AMI, suggesting that acute exacerbations of COPD are associated with an increased risk of acute coronary syndromes.

ORIGINAL ARTICLE, Deep Intramuscular Methylprednisolone Treatment of Recurrent Scleritis

Purpose: To evaluate the efficacy of deep intramuscular methylprednisolone (IMMP) in the treatment of recurrent scleritis. Methods: A total of 15 patients with scleritis (12 anterior, 3 pan) underwent IMMP injection deep into the thigh. Thirteen patients were already being treated with oral non-steroidal anti-inflammatory drugs, oral prednisolone, an oral immunosuppressive agent, or a combination of these drugs. A second IMMP injection was given to nine patients, making a total of 24 injections. Follow-up ranged from 4 to 18 months. Results: There was a documented improvement in scleritis after 21/24 (87.3%) injections with a mean duration of improvement of 5.7 months. No patient required the introduction of oral corticosteroid or immunosuppressive agent, and only one patient required an increase in methotrexate to control the disease. No systemic, injection site, or ocular side effects were noted. Conclusions: Deep IMMP is a safe and effective treatment for scleritis. It ensures compliance, avoids the systemic side effects of oral corticosteroids, and is easily repeatable in the outpatient setting.

Adherence of Pediatric Asthma Patients With Oral Corticosteroid Prescriptions Following Pediatric Emergency Department Visit or Hospitalization

To determine caregiver adherence to oral corticosteroids prescribed in the emergency department for pediatric patients with an acute asthma exacerbation and to identify caregivers' perceived barriers to adherence with prescribed oral corticosteroids. We conducted telephone interviews 7 to 9 days following a patient's presentation to an urban children's hospital emergency department for an acute asthma exacerbation. The telephone interview conducted with caregivers of pediatric asthma patients included questions regarding whether caregivers filled a prescription for an oral corticosteroid, the number of days the caregiver gave the medication, and the perceived barriers to adherence by the caregiver. During the study period, oral corticosteroid prescriptions were written for 161 of 172 patients completing the phone interview (93.6%). Of these patients, 98.7% reported filling the prescription, with caregivers of female patients and adolescent patients less likely to fill prescriptions than caregivers of male and younger patients. Asthma patient caregivers, however, reported adherence to the prescribed length of oral corticosteroid therapy only 64% of the time. Caregivers worried about the side effects of oral corticosteroids 60% of the time. Efforts to increase corticosteroid adherence in children with acute asthma exacerbations should consider the causes for variation in caregiver adherence with length of therapy as well as caregiver perceptions regarding corticosteroid side effects.

Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up

Background: Previous allergic fungal sinusitis case reports have speculated that oral corticosteroids might reduce the severity of disease and possibly forestall the high rate of recurrent sinus surgery. Objectives: Our objective was to comprehensively review 67 consecutive cases of allergic fungal sinusitis for their response to treatment and the utility of monitoring patient serologies during clinical follow-up. Methods: Allergic fungal sinusitis cases from a private practice were evaluated and treated with consistent diagnostic criteria and treatment paradigms. An 8-year retrospective review of serologic parameters and clinical response to treatment with or without oral corticosteroids is described. Results: The total serum IgE was found to correlate with the clinical rhinosinusitis severity ( P = .0002). The fungal-specific IgG also correlated with clinical rhinosinusitis severity but less rigorously ( P = .004). An increase of 10% or more in total serum IgE during follow-up was found to have significant predictive value for recurrent surgical intervention, with a sensitivity of 79%, specificity of 77%, positive predictive value of 48%, and negative predictive value of 93% ( P < .0001). With the use of a modified corticosteroid treatment regimen adapted from allergic bronchopulmonary aspergillosis, as little as 2 months of oral corticosteroids after surgery provided significant clinical improvement for up to 12 months ( P < .0001), although patients taking 12 months of treatment fared the best clinically ( P = .03). By survival analysis, oral corticosteroids prolonged the time between subsequent sinus surgeries ( P = .01) in this highly recurrent disease. No significant side effects of oral corticosteroids were observed during treatment with this dosing regimen. Conclusions: Postoperative oral corticosteroids appear to be an effective treatment option for allergic fungal sinusitis, and monitoring of total serum IgE can be helpful in the clinical follow-up of these patients. (J Allergy Clin Immunol 1998;102:395-402.)