A perspective on systemic corticosteroid therapy in severe bronchial asthma in adults

Klaustermeyer, William B.; Choi, Soo Hwan

doi:10.2500/aap.2016.37.3941

Cited by 9 publications

(6 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[ 26 , 29 – 31 ] Studies comparing oral with intravenous corticosteroids in the acute exacerbation of asthma also support the use of oral corticosteroids. [ 32 – 35 ] The result of our study agreed with the experience in the field of AECOPD and asthma. This result may be explained by the similar bioavailability of oral with intravenous corticosteroids.…”

Section: Discussionsupporting

confidence: 87%

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

BackgroundIntravenous glucocorticoids are recommended for multiple sclerosis (MS). However, they can be inconvenient and expensive. Due to their convenience and low cost, oral glucocorticoids may be an alternative treatment. Recently, several studies have shown that there is no difference in efficacy and safety between oral methylprednisolone (oMP) and intravenous methylprednisolone (ivMP).ObjectivesWe sought to assess the clinical efficacy, safety and tolerability of oral methylprednisolone versus intravenous methylprednisolone for MS relapses in this meta-analysis.MethodsRandomized controlled trials (RCTs) evaluating the clinical efficacy, safety and tolerability of oral methylprednisolone versus intravenous methylprednisolone for MS relapses were searched in PubMed, Cochrane Library, Medline, EMBASE and China Biology Medicine until October 25, 2016, without language restrictions. The proportion of patients who had improved by day 28 was chosen as the efficacy outcome. We chose the risk ratio (RR) to analyze each trial with the 95% confidence interval (95% CI). We also used the fixed-effects model (Mantel–Haenszel approach) to calculate the pooled relative effect estimates.ResultsA total of 5 trials were identified, which included 369 patients. The results of our meta-analysis revealed that no significant difference existed in relapse improvement at day 28 between oMP and ivMP (RR 0.96, 95% CI 0.84 to 1.10). No evidence of heterogeneity existed among the trials (P = 0.45, I2 = 0%). Both treatments were equally safe and well tolerated except that insomnia was more likely to occur in the oMP group compared to the ivMP group.ConclusionOur meta-analysis reveals strong evidence that oMP is not inferior to ivMP in increasing the proportion of patients experiencing clinical improvement at day 28. In addition, both routes of administration are equally well tolerated and safe. These findings suggest that we may be able to replace ivMP with oMP to treat MS relapses.

show abstract

Section: Discussionsupporting

confidence: 87%

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Intravenous steroids should be given early during severe bronchospasm but they will only be effective after several hours. Intravenous methylprednisolone has an onset time of 1-2 hours with a peak effect at 4-6 hours [60]. Other agents need to be relied upon to control the bronchospasm until this time.…”

Section: Steroidmentioning

confidence: 99%

A Contemporary Approach to the Treatment of Perioperative Bronchospasm

Bohringer

Daniel²,

Liu³

2020

Transl Perioper & Pain Med

View full text Add to dashboard Cite

The incidence of asthma is increasing, and the ageing of the United States population is leading to an increase in the prevalence of patients living with chronic obstructive pulmonary disease. This has led to an increased need to manage bronchospasm in the perioperative period. Very effective methods to treat bronchospasm like intravenous dexmedetomidine, lidocaine, magnesium, ketamine and steroids as well as inhalational sevoflurane are available but are currently underused. Inhaled beta-2 agonists like albuterol are instead often relied upon as the sole therapeutic agent -often with limited response. Just like with pain management, the successful treatment of perioperative bronchospasm requires a multimodal approach. The diagnosis of intraoperative bronchospasm must be rapid, and the treatment must be effective to prevent the dreaded "dynamic hyperinflation syndrome". This article reviews the diagnosis of bronchospasm and the contemporary treatment methods that should be employed to prevent bronchospasm-related morbidity and mortality during the perioperative period.

show abstract

“…There is a subgroup of patients refractory to all treatments, including OCS, who have a poor control of asthma symptoms with recurrent exacerbations. This leads to a serious deterioration in the quality of life (QoL), loss of working or school days, and increased individual and social costs with consistent consumption of health care resources including hospitalization in the intensive care unit (ICU) [1,2]. The advent of omalizumab and subsequently of bronchial thermoplasty (BT) have made it possible to meet the needs of a significant number of patients with severe refractory asthma.…”

Section: Introductionmentioning

confidence: 99%

Long-term responsiveness to mepolizumab after failure of omalizumab and bronchial thermoplasty: Two triple-switch case reports

Lombardi

Menzella²,

Passalacqua

2020

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

Severe asthma affects between 5 and 10% of patients with asthma worldwide and requires best standard therapies at maximal doses. A subgroup of patients remains refractory to all treatments. We describe two case reports with severe allergic asthma who progressively worsened over the years despite the best therapy. The patients were first treated with omalizumab, which was completely ineffective, and then with bronchial thermoplasty (BT), again without clinical benefit. Since our patients met the AIFA criteria for inclusion in mepolizumab treatment, a therapy with this anti-IL5 biological agent was initiated. In the first case (a 53-year-old female), after the second mepolizumab administration, symptoms improved progressively, with a reduction in the number and severity of exacerbations, so the patient could finally be discharged from hospital. At follow-up, it was possible to reduce oral corticosteroids and continuing with inhaled corticosteroids/long-acting beta-agonists and montelukast. The patient had only one exacerbation/year. Symptom control and quality of life improved significantly. In the second case report (a 55-year-old male), after the sixth mepolizumab administration, symptoms improved progressively, with a reduction in the number and severity of exacerbations. At follow-up, it was possible to reduce and stop oral corticosteroids, continuing with inhaled therapy and montelukast. Symptom control and quality of life improved significantly.These are the first cases of patients unresponsive to sequential omalizumab and BT but with good and prolonged clinical response to mepolizumab. Both cases suggest that also after the failure of two consecutive third-line treatments, a third treatment (mepolizumab) should be attempted.

show abstract

A perspective on systemic corticosteroid therapy in severe bronchial asthma in adults

Abstract: Until we have a better understanding of the mechanisms of action of glucocorticoids, we will continue to rely on currently available systemic corticosteroids in severe asthma. The intrapatient consistency as discussed in this review, should guide therapy.

Cited by 9 publications

References 51 publications

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

A Contemporary Approach to the Treatment of Perioperative Bronchospasm

Long-term responsiveness to mepolizumab after failure of omalizumab and bronchial thermoplasty: Two triple-switch case reports

Contact Info

Product

Resources

About