Corticosteroid Usage Research Articles

Diagnosis and treatment of drug-induced interstitial lung disease

Drug-induced interstitial lung disease (DILD) is a group of adverse drug reactions that is rare but fatally toxic. Pulmonary toxicity causes inflammation and subsequent interstitial fibrosis. As novel drugs with a variety of purposes are introduced into the medical field, the number of culprit medications that are suspected to cause lung complications is accordingly increasing. In this review, DILD will be discussed from several aspects such as causality by numerous drugs, check points for a timely diagnosis, alongside some contemporary treatment options. The exact mechanism of DILD has not been elucidated, and a useful clinical, radiological, or pathological confirmation process is still lacking. Common drugs which casue DILD include bleomycin, amiodarone, epidermal growth factor receptor-targeted agents, and immune checkpoint inhibitors. Diagnosis is based on a suspicious drug administration history, somewhat inconsistent clinical symptoms and signs, radiological hints, and histopathological assistance, together with the exclusion of other lung-injuring etiologies. Cessation of the suspected drug, meticulous corticosteroid usage, and ancillary supportive management are the mainstay therapeutic strategy for DILD. Most cases of DILD respond to these countermeasures and reductions, but in some cases the fibrotic process worsens, leading to irreversible sequelae on the affected lung.

Single Stage Simultaneous Core Decompression for Ficat Stage I and II Bilateral Femoral Head Osteonecrosis among Hip Surgeries done in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Osteonecrosis of femoral head is a disease affecting young individuals and often occurs in bilateral hips. The purpose of this study is to find out the prevalence of single stage simultaneous core decompression for Ficat stage I and II bilateral femoral head osteonecrosis among total hip surgeries done in a tertiary care center. A descriptive cross-sectional study was conducted at a tertiary care trauma centre from April 2017 and March 2020. Ethical approval was obtained from the Institutional Review Committee prior to data collection (Reference no: 673/2077/78). Convenience sampling was done. Patients undergoing hip surgeries were included in the study. Patients with missing data were excluded. Patients operated upto Ficat Stage IIb femoral head osteonecrosis were followed up. Data was analysed using the Statistical Package for Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Out of 916 patients who underwent hip surgeries, 12 (1.31%) (0.57-2.04 at 95% Confidence Interval) underwent single stage simultaneous core decompression. Idiopathic cause in 6 (50%) and prolonged corticosteroid usage in 4 (33.33%) were the leading causes. Twelve (50%) of the treated hips were in Ficat stage IIa. At the end of one year, of the 11 patients who followed up, 12 (54.5%) hips had a good Harris hip outcome. Our study showed that a small proportion of hip surgeries were single stage simultaneous bilateral core decompression for osteonecrosis of femoral head in our setting. Our findings were similar to studies done internationally with a very low complication rate.

Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy.

Background and AimPercutaneous endoscopic gastrostomy (PEG) has been used in patients with dysphagia and inadequate food intake via an oral route. Despite being a procedure with a high success rate, complications and death have been reported. The aim was to identify the factors related to major complications and mortality, as well as PEG removal prognostic factors due to improvement of their general condition.MethodsPatient characteristics, comorbidities, laboratory data, concomitant medication, sedation, and indication for PEG placement were collected. Major complications, mortality, and PEG removal factors were assessed.ResultsA total of 388 patients were enrolled. There were 15 (3.9%) cases of major complications, with major bleeding being the most frequent in 6 (1.5%) patients. Corticosteroids were the independent variable associated with major complications (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.71–20; P = <0.01). Advanced cancer (hazard ratio [HR] 0.5; 95% CI 0.3–1; P = 0.05), albumin (HR 0.6; 95% CI 0.4–0.9; P = <0.01), and C‐reactive protein (CRP) (HR 1.1; CI 1–1.2; P = 0.01) were considered risk factors for mortality. Previous pneumonia (HR 0.4; CI 0.2–0.9; P = 0.02) was a factor for permanent use of a PEG; however, oncological indication (HR 8.2; CI 3.2–21; P = <0.01) was factors for PEG withdrawal.ConclusionsChronic corticosteroid users potentially present with major complications. Low albumin levels and elevated CRP were associated with death. Previous aspiration pneumonia was a factor associated with permanent use of PEG; however, patients with oncological indication were the most benefited.

Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction: a nationwide case-control registry study.

ObjectiveTo investigate the long-term outcomes of patients with RA after myocardial infarction (MI).MethodsAll-comer, real-life MI patients with RA (n = 1614, mean age 74 years) were retrospectively compared with propensity score (1:5) matched MI patients without RA (n = 8070) in a multicentre, nationwide, cohort register study in Finland. The impact of RA duration and the usage of corticosteroids and antirheumatic drugs on RA patients’ outcomes were also studied. The median follow-up was 7.3 years.ResultsRA was associated with an increased 14-year mortality risk after MI compared with patients without RA [80.4% vs 72.3%; hazard ratio (HR) 1.25; CI: 1.16, 1.35; P <0.0001]. Patients with RA were at higher risk of new MI (HR 1.22; CI: 1.09, 1.36; P =0.0001) and revascularization (HR 1.28; CI: 1.10, 1.49; P =0.002) after discharge from index MI. Cumulative stroke rate after MI did not differ between RA and non-RA patients (P =0.322). RA duration and corticosteroid usage before MI, but not use of methotrexate or biologic antirheumatic drugs, were independently associated with higher mortality (P <0.001) and new MI (P =0.009). A higher dosage of corticosteroids prior to MI was independently associated with higher long-term mortality (P =0.002) and methotrexate usage with lower stroke rate (P =0.034). Serological status of RA was not associated with outcomes.ConclusionRA is independently associated with poorer prognosis after MI. RA duration and corticosteroid usage and dosage were independent predictors of mortality after MI in RA. Special attention is needed for improvement of outcomes after MI in this vulnerable population.

Association of Anti–Tumor Necrosis Factor Therapy With Mortality Among Veterans With Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is commonly treated with corticosteroids and anti-tumor necrosis factor (TNF) drugs; however, medications have well-described adverse effects. Prior work suggests that anti-TNF therapy may reduce all-cause mortality compared with prolonged corticosteroid use among Medicare and Medicaid beneficiaries with IBD. To examine the association between use of anti-TNF or corticosteroids and all-cause mortality in a national cohort of veterans with IBD. This cohort study used a well-established Veteran's Health Administration cohort of 2997 patients with IBD treated with prolonged corticosteroids (≥3000-mg prednisone equivalent and/or ≥600 mg of budesonide within a 12-month period) and/or new anti-TNF therapy from January 1, 2006, to October 1, 2015. Data were analyzed between July 1, 2019, and December 31, 2020. Use of corticosteroids or anti-TNF. The primary end point was all-cause mortality as defined by the Veterans Health Administration vital status file. Marginal structural modeling was used to compare associations between anti-TNF therapy or corticosteroid use and all-cause mortality. A total of 2997 patients (2725 men [90.9%]; mean [SD] age, 50.0 [17.4] years) were included in the final analysis, 1734 (57.9%) with Crohn disease (CD) and 1263 (42.1%) with ulcerative colitis (UC). All-cause mortality was 8.5% (n = 256) over a mean (SD) of 3.9 (2.3) years' follow-up. At cohort entry, 1836 patients were new anti-TNF therapy users, and 1161 were prolonged corticosteroid users. Anti-TNF therapy use was associated with a lower likelihood of mortality for CD (odds ratio [OR], 0.54; 95% CI, 0.31-0.93) but not for UC (OR, 0.33; 95% CI, 0.10-1.10). In a sensitivity analysis adjusting prolonged corticosteroid users to include patients receiving corticosteroids within 90 to 270 days after initiation of anti-TNF therapy, the OR for UC was statistically significant, at 0.33 (95% CI, 0.13-0.84), and the OR for CD was 0.55 (95% CI, 0.33-0.92). This study suggests that anti-TNF therapy may be associated with reduced mortality compared with long-term corticosteroid use among veterans with CD, and potentially among those with UC.

Applications of corticosteroids in oral diseases: A review

Steroids being one of the most broadly used drugs in dentistry which readily act as immunosuppressive agents. Corticosteroids have modernized the treatment protocol of several disease conditions inclusive of many oral diseases. These are strong and effective anti-inflammatory drugs resembling cortisol (inherently formed hormone by the body). Their function is to decrease inflammation, particularly when the body inaccurately activates inflammatory system. Oral and maxillofacial disease may be either local or occur due to the expression of any systemic problem. There are many oral and maxillofacial clinicians who apply the usage of corticosteroids established on their effectiveness to control consequences of any dental procedure or surgery and also to produce and render a contented post-operative period. Hence, the present review highlights and focuses on the pharmacology, uses, contraindications and side-effects of corticosteroids application in oral diseases. Keywords: Glucocorticoids, Cosrticosteroids, Antiinflammatory, Immunosuppression.

Can indocyanine green perfusion imaging detect microangiopathy in mastectomy skin flaps?

Intraoperative vascular imaging using indocyanine green (ICG) angiography may better predict flap viability than clinical judgement alone. Intraoperative ICG angiography was used in a chronic corticosteroid user undergoing bilateral nipple sparing mastectomy with expander placement. Large blood vessels were visualized, however, the skin surrounding these vessels remained dark. The flap demarcated to full-thickness necrosis that matched the intraoperative SPY findings. Visualization of intact blood vessels may not be sufficient to rule out flap necrosis in some patients. In these circumstances, interpretation of perfusion with consideration of patient factors will be required to accurately predict flap viability.

Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for...

Detection of 28 Corticosteroids in Pharmaceutical and Proprietary Chinese Medicinal Products Using Liquid Chromatography-Tandem Mass Spectrometry.

With their potent anti-inflammatory effects, corticosteroids are popular adulterants in illicit health products for allergies, dermatitis and pain control. Their illegal supply over the counter is also a common practice for similar conditions. Prolonged, unsupervised usage of corticosteroids often leads to severe adverse effects including Cushing syndrome, adrenal insufficiency and immunosuppression. Confirming clinical suspicion of unsupervised corticosteroid usage is challenging. Apart from evaluating the adrenal function, identifying the concerned drug is the most direct proof of its consumption. While detecting corticosteroids or their metabolites in biological specimens is convincing evidence of their usage, such approach is analytically difficult. More importantly, this approach would not be useful if the patient has stopped taking the drug for some time-a situation that is often encountered clinically. We advocate a more direct approach by measuring corticosteroids in suspicious medicinal products. In the current study, a liquid chromatography-tandem mass spectrometry method for simultaneous detection of 28 corticosteroids in pharmaceutical and proprietary Chinese medicine products was developed and validated for the purpose. The method was applied to 388 cases of suspected unsupervised corticosteroids usage. Among 1,000 products tested, corticosteroids were found in 276 of them and confirmed the clinical suspicion.

Longitudinal outcomes of body mass index in overweight and obese children with chronic kidney disease

BackgroundLongitudinal changes in body mass index (BMI) among overweight and obese children with chronic kidney disease (CKD) are not well characterized. We studied longitudinal trajectories and correlates of these trajectories, as results may identify opportunities to optimize health outcomes.MethodsLongitudinal changes in age-sex-specific BMI z-scores over 1851 person-years of follow-up were assessed in 524 participants of the Chronic Kidney Disease in Children Study. A total of 353 participants were categorized as normal (BMI > 5th to < 85th percentile), 56 overweight (BMI ≥ 85th to 95th percentile) and 115 obese (BMI ≥ 95th percentile) based on the average of three BMI measurements during the first year of follow-up. Studied covariates included age, sex, race, CKD etiology, corticosteroid usage, household income, and maternal education.ResultsIn unadjusted analysis, BMI z-scores decreased over time in elevated BMI groups (overweight: mean = − 0.06 standard deviations (SD) per year, 95% CI: − 0.11, − 0.01; obese: mean = − 0.04 SD per year, 95% CI: − 0.07, − 0.01). Among obese children, only age was associated with change in BMI z-score; children < 6 years had a mean decrease of 0.19 SD during follow-up (95% CI: − 0.30, − 0.09). Socioeconomic factors were not associated with change in BMI.ConclusionOverweight and obese children with CKD demonstrated a significant annual decline in BMI, though the absolute change was modest. Among obese children, only age < 6 years was associated with significant decline in BMI. Persistence of elevated BMI in older children and adolescents with CKD underscores the need for early prevention and effective intervention.

Survival outcomes associated with corticosteroid use before chemoimmunotherapy in patients with advanced lung cancer

BackgroundHow corticosteroid use affects treatment response to chemotherapy and immune-checkpoint inhibitors (CICPIs) remains unknown. We assessed how systemic corticosteroid exposure before CICPI modifies the effect of CICPI on outcomes among patients with metastatic non-small cell lung cancer (mNSCLC) or extensive-stage small-cell lung cancer (ES-SCLC). MethodsWe conducted a retrospective cohort study using electronic health records to examine patients with mNSCLC or ES-SCLC who received chemotherapy (CT) between 1st April 2015 and 31st January 2018 or CICPI between 1st February 2018 and 31st August 2019. We excluded those with an actionable driver mutation. Baseline corticosteroid use was defined as systemic corticosteroids within 28 days before the initiation of CT or CICPI, not including premedications. Coprimary outcomes included overall survival (OS), real-world progression (rwP), and real-world progression-free survival (rwPFS) in CICPI-treated corticosteroid users versus non-users. We used inverse probability of treatment weighting (IPW) to adjust for potential confounding. ResultsThe cohort of 316 patients (median [interquartile range] age, 67 [61–73] years; 156 [49%] male) included 228 CT-treated and 88 CICPI-treated patients. After applying IPW, characteristics were well-balanced between the CT and CICPI groups, and steroid users and non-users. Using CT-treated steroid non-users as a common comparator, CICPI-treated steroid users were as likely as CICPI-treated steroid non-users to die (users IPW hazard ratio [HR] = 0.67, 95% CI = 0.35–1.28 versus non-users IPW-HR = 0.88, 95% C = I0.55–1.42; p = 0.49), have rwP (IPW-HR = 0.35, 95% C = I0.12–0.99 versus IPW-HR = 0.41, 95% C = I0.24–0.70; p = 0.77), or experience rwPFS (IPW-HR = 0.56, 95% C = I0.29–1.09 versus IPW-HR = 0.69, 95% CI0.46–1.03; p = 0.59). ConclusionCorticosteroid use before CICPIs was not associated with worse outcomes, suggesting that corticosteroids should be used with CICPIs when indicated.

A black intruder into the Pandemic: Rhino-Orbital Mucormycosis Complicating COVID-19

There is an increased incidence of rhino orbital mucormycosis during the Coronavirus Disease-2019 (COVID-19) pandemic attributed to diabetes mellitus, corticosteroid usage and immunocompromise caused by COVID-19. In this series, seven biopsy proven cases of mucormycosis (six male patients and one female patient) are presented from a tertiary care center in Eastern India from (May 2021 to June 2021). Empirical systemic liposomal amphotericin B, radical sinus surgery with orbital decompression and irrigation of sinus and orbit with amphotericin B was performed. The mean age of the patients were 42.71±7.34 years with a male preponderance (85.7%). Five patients had orbital involvement (71.42%), and two had cerebral involvement (28.6%). All of them had elevated blood glucose levels, though only three (42.85%) were known cases of type 2 diabetes. The most common manifestations were sinus tenderness (100%), paresthesia (100%), facial swelling (71.42%) and nasal discharge (28.57%). Follow-up at two months showed zero mortality. Timely diagnosis, appropriate management with intravenous amphotericin B and endoscopic radical sinus surgery, debridement of the necrotic tissue proved to be necessary for a good outcome in rhino-orbito-cerebral mucormycosis.

Bilateral Central Serous Retinopathy in Patient with Chronic Kidney Disease on Haemodialysis: A Case Report

Central Serous Chorioretinopathy (CSCR) is the detachment of the neurosensory retina and/or Retinal Pigment Epithelium (RPE) due to accumulation of fluid in the sub retinal space, mostly confined to the macula. Hereby, presenting a rare case of a 32-year-old patient with defective vision in both eyes, she was a known case of Chronic Kidney Disease (CKD) on haemodialysis. On examination best corrected visual acuity was 6/9, on dilated fundus examination with ring reflex in both eyes, Optical Coherence Tomography (OCT) macula showed detachment of the neurosensory retina from RPE with the sub retinal fluid. This case is considered to be rare due to the unusual association noted between CSCR and End State Renal Disease (ESRD), in a female patient with no history of usage of corticosteroids or known identifiable risk factors. Hence, it is essential to screen patients with ESRD for CSCR to prevent vision threatening complications.

Adrenal Insufficiency Caused by Chronic Corticosteroid Use, Identified through Medication Therapy Management

OBJECTIVE: To report a case of adrenal insufficiency caused by chronic corticosteroid treatment.Summary: This case study describes a 71-year-old Caucasian woman diagnosed with secondary adrenal insufficiency (SAI). She had a long history of multiple medical problems that affected her quality of life. The pharmacist reviewed 18 years (2001-2018) of medical records, including her corticosteroid usage history. The patient had been receiving chronic medium-high dose inhaled corticosteroids for asthma, with intermittent oral prednisone for exacerbations. The pharmacist suspected a possible SAI or tertiary adrenal insufficiency (TAI) caused by hypothalamic pituitary adrenal axis suppression induced by chronic corticosteroid use. After discussions with the patient's primary care physician and a screening adrenal function test, the patient was referred to an endocrinologist, and the diagnosis was confirmed. Low-dose hydrocortisone (<30 mg daily) was prescribed; the patient had improvements in mood, skin hyperpigmentation, and asthma symptoms, which eliminated the routine visits to the emergency room/clinic during the winter season.CONCLUSION: The case illustrated the benefits of utilizing a pharmacist's expertise. A consultant pharmacist can identify an underdiagnosed and rare condition, corticosteroid-induced adrenal insufficiency, through comprehensive medication review in a community medication therapy management service setting.

Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis

Objective To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). Methods Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. Results Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28–1.77; p < .0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28–2.04; p < .0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients (p = .060). Duration of RA before CABG (p = .011) and preoperative corticosteroid usage in RA (p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. Conclusions RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality. Key messages Patients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG). Glucocorticoid use before CABG and duration of RA are associated with higher mortality. Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.

Awareness of corticosteroids’ side effects among attendees in King Fahad Specialist Hospital, Buraydah city, Saudi Arabia

Background: Corticosteroids “steroids” are anti-inflammatory drugs prescribed to reduce inflammation and suppress the immune system in many conditions such as asthma, allergic rhinitis, systemic lupus erythematosus, urticaria, inflammatory bowel diseases, inflamed joints. Steroids are one of the most widely prescribed drugs. Despite its severe side effects, only a few studies have been reported the severity of the problem and the awareness of the patients in Saudi Arabia. This study primarily is focused on assessing understanding for corticosteroid users or non-user about corticosteroids’ adverse effects with different usage of dosage forms among attendees in King Fahad Specialist Hospital (KFSH) in Buraydah city. Methods: A cross-sectional survey was conducted. Convenient sampling was taken from attendees in KFSH in Buraydah city. The sample consisted of users and non-users for the corticosteroids drugs in any form, whether in outpatient or inpatients or visitors. Results: Overall, in our study, we found a low level of awareness among attendees “users and non-users” in KFSH about the adverse effects of corticosteroids, and the awareness of users was higher than non-users. Conclusion: Corticosteroid therapy is essential in clinical practice, yet it can have significant side effects if misused. Overall, we discovered that attendees at KFSH had a poor level of awareness of corticosteroids’ side effects; additionally, users were more aware of side effects than non-users, and the incidence of the disease will increase awareness about side effects. Younger age groups were more aware, and there was minimal variation of understanding in gender.

Anthropometrics and Metabolic Syndrome in Relation to Glucocorticoid Receptor Polymorphisms in Corticosteroid Users

Introduction: Corticosteroids are widely prescribed and their use has been linked to adverse cardiometabolic outcomes. A pivotal role in the action of corticosteroids is reserved for the glucocorticoid receptor (GR). Here, we assessed the relationship of glucocorticoid sensitivity-altering GR polymorphisms with anthropometrics and metabolic syndrome (MetS) in corticosteroid users. Methods: In this population-based cohort study (Lifelines), we genotyped 10,621 adult participants for GR hypersensitive (1/2 copies BclI and/or N363S) and GR resistant (1/2 copies ER22/23EK and/or 9β) variants. We assessed the relationship between functional GR polymorphisms with BMI, waist circumference (WC), and MetS in users of corticosteroids. Results: Overall corticosteroid use was associated with a significantly higher BMI and WC in GR wild-type (WT) users (BMI, +0.63 kg/m² [0.09–1.16], p = 0.022; WC, +2.03 cm [0.61–3.44], p = 0.005) and GR hypersensitive (BMI, +0.66 kg/m² [95% CI, 0.31–1.01]; WC, +2.06 cm [1.13–2.98], both p < 0.001) but not in GR resistant users. Significantly higher WC in GR resistant carriers was observed only for inhaled corticosteroid users. With respect to MetS, again only GR WT users (odds ratio [OR] 1.44 [1.07–1.94], p = 0.017) and GR hypersensitives (OR 1.23 [95% CI, 1.00–1.50], p = 0.046) were more likely to have MetS; even more pronounced in only inhaled corticosteroid users (GR WT users, OR 1.64 [1.06–2.55], p = 0.027; GR hypersensitive users, OR 1.43 [1.08–1.91], p = 0.013). Conclusions: Polymorphisms associated with increased GR sensitivity and WT GR are related to increased BMI, WC, and an increased MetS presence in corticosteroid users, especially of the inhaled types, when compared to nonusers. The adverse effects of corticosteroid use are less pronounced in users harboring GR resistant polymorphisms.

Airway regulatory T cells are decreased in COPD with a rapid decline in lung function

BackgroundDifferences in the expression of regulatory T cells (Tregs) have been suggested to explain why some smokers develop COPD and some do not. Upregulation of Tregs in response to smoking would restrain airway inflammation and thus the development of COPD; while the absense of such upregulation would over time lead to chronic inflammation and COPD. We hypothesized that—among COPD patients—the same mechanism would affect rate of decline in lung function; specifically, that a decreased expression of Tregs would be associated with a more rapid decline in FEV1.MethodsBronchoscopy with BAL was performed in 52 subjects recruited from the longitudinal OLIN COPD study; 12 with COPD and a rapid decline in lung function (loss of FEV1 ≥ 60 ml/year), 10 with COPD and a non-rapid decline in lung function (loss of FEV1 ≤ 30 ml/year), 15 current and ex-smokers and 15 non-smokers with normal lung function. BAL lymphocyte subsets were determined using flow cytometry.ResultsThe proportions of Tregs with regulatory function (FoxP3+/CD4+CD25bright) were significantly lower in COPD subjects with a rapid decline in lung function compared to those with a non-rapid decline (p = 0.019). This result was confirmed in a mixed model regression analysis in which adjustments for inhaled corticosteroid usage, smoking, sex and age were evaluated. No significant difference was found between COPD subjects and smokers or non-smokers with normal lung function.ConclusionsCOPD subjects with a rapid decline in lung function had lower proportions of T cells with regulatory function in BAL fluid, suggesting that an inability to suppress the inflammatory response following smoking might lead to a more rapid decline in FEV1.Trial registration Clinicaltrials.gov identifier NCT02729220

Effect of systemic corticosteroid use on risk of herpes zoster in a population-based cohort study

Background: Herpes zoster (HZ) has been associated with corticosteroid use among patients with rheumatoid arthritis or inflammatory bowel diseases however there is a lack of data on the associated risk in the general population and how it may vary by different doses and how long the increased risk lasts. Methods & Materials: Using data from a large cohort of adults (the 45 and Up Study) recruited between 2006 and 2008 and linked to pharmaceutical dispensing, hospital, and death data, the effect of corticosteroid use on zoster risk was analysed using Cox proportional hazards models, adjusting for age, sex and other characteristics. Age, cumulative dose of systemic corticosteroids and comorbidities were treated as time-varying covariates in analyses. Results: There were 94,677 participants, mean age 70.1 (±9.8) years included. Over 184,659 person-years (mean 1.95 years), there were 6001 new systemic corticosteroid users and 1847 incident HZ events. The risk of HZ increased by 69% in those using systemic corticosteroids (aHR 1.69 [95%CI 1.36–2.10]). There was a 3% estimated increase of HZ risk for every 100 mg increase in cumulative prednisolone equivalents (P for trend <0.001). For those who used over 500 mg prednisolone equivalents the risk of HZ was 2 times of that in non-users (aHR 2.15 [95%CI 1.65–2.80]). After dividing time before and following a single episode of corticosteroid use into intervals, we found while HZ risk prior to systemic corticosteroids use was similar to non-users, it increased substantially in the first month following use (aHR 6.19 [95%CI 5.00–7.66]) and returned to a similar level as non-users by the third month (aHR 0.94 [95%CI 0.50–1.74]). Those using systemic corticosteroids either with or without comorbidities had higher HZ risks than those without any systemic corticosteroid use nor comorbidities (with comorbidities: aHR 2.15 [95%CI 1.49–3.09]; without comorbidities: aHR 1.58 [95%CI 1.21–2.06]). Conclusion: Systemic corticosteroid use at high cumulative doses (≥500 mg prednisolone equivalent) was associated with an increased HZ risk and was particularly high for at least a month after use commences. Our results reinforce the need to use corticosteroids judiciously and supports the current recommendations to avoid live-attenuated zoster vaccines in those using systemic corticosteroids.

Clinical, functional and laboratory characteristics of patients with asthma-COPD overlap

Objective: to access some clinical, functional and laboratory features of patients with asthma-COPD overlap (ACO).Material and methods. Our study involved 120 patients and two ACO groups were created: asthmatic smokers - Group I and COPD patients with high degree of reversibility of airflow limitation and eosinophilic COPD (eosinophil blood count ≥2% and 200 cell/ml) - Group II. All the other COPD subjects – Group III. The spirometry testing were performed using computer spirograph «BTL-08SpiroPro» (Great Britain). Weight and body composition variables were measured with a body composition monitor (BC-601 Tanita, Japan). Blood eosinophils and total IgE levels were estimated. «Microsoft Excel», «Statistica» were used for mathematical and statistical analysis.Results. There were 28,3% of participants classified as ACO. The combination of long-acting beta-agonist and inhaled corticosteroids usage rate was higher among asthmatic smokers (2,3 and 1,8 times higher than in Group II and Group III respectively), as well as short acting beta-agonist and oral corticosteroid usage rates (1,7 and 2,3 times higher in Group I compared to Group II). The peripheral blood eosinophil and serum IgE levels were 1,8 and 3,3 times higher (p&lt;0,05) in Group II than in Group I and III. FEVI was higher in Group I by 7,6% and in Group II by 11,8% than in COPD. It has been demonstrated that among Group II subjects there was higher BMI( by 28,8% and 22,2% (p&lt;0,05)), the body fat percentage ( by 19,7% and 41,3% (р&lt;0,05)), the visceral fat level (by 16,7% and 20,3%(р&lt;0,05)) and the muscle mass(by 10,8% and 15,5%(р&lt;0,05)) than in asthmatic smokers and COPD patients respectively.Conclusion. The prevalence of ACO (asthmatic smokers, eosinophilic COPD and COPD with high degree of reversibility) among the examined subjects was 28,3%. COPD patients with high degree of reversibility and eosinophilic inflammation are characterized by higher blood eosinophil and total serum IgE levels, higher FEV1, amount of visceral fat, body fat percentage and especially muscle muss.