Azathioprine as an oral corticosteroid sparing agent for asthma

Dean, Tara; Dewey, Ann; Bara, Anna; Lasserson, Toby J; Walters, EH

doi:10.1002/14651858.cd003270.pub2

Cited by 28 publications

(23 citation statements)

References 8 publications

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“…Evidence is lacking for the use of so-called steroidsparing agents, such as azathioprine, chloroquine, cyclosporine, gold, and methotrexate. [28][29][30][31][32] However, add-on therapies, such as macrolides, anti-immunoglobulin E, tumor necrosis factor alpha inhibitors, cytokine receptor antagonists, and bronchial thermoplasty, are developing as alternative options in refractory asthma care. 33,34 Inhaled Versus Systemic Route of Short-Acting ␤-Agonist Administration According to the latest global strategy for asthma management and prevention report of the Global Initiative for Asthma, asthma treatment for adults is divided into controller and reliever categories, each administered via inhalation, orally, or parenterally (subcutaneous, intramuscular, or intravenous injection).…”

Section: Discussion Current Evidence-based Asthma Management and Carementioning

confidence: 99%

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

2015

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INTRODUCTION:Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway. METHODS: This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment. RESULTS: Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P ‫؍‬ .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P ‫؍‬ .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S pO 2 increased at 5 min post-treatment with ELB. In contrast, S pO 2 decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P ‫؍‬ .92) and ELB conditions (P ‫؍‬ .18). CONCLUSIONS: ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI. Key words: albuterol liquid bolus; albuterol lavage; novel use albuterol. [Respir Care 2015;60(5):627-635.

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Section: Discussion Current Evidence-based Asthma Management and Carementioning

confidence: 99%

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

2015

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“…Azathioprine is another immunosuppressive agent that is used as an oral corticosteroid-sparing agent [108]. Azathioprine inhibits purine synthesis and thus inhibits lymphocyte proliferation [109].…”

Section: Drug Use For An Unapproved Indicationmentioning

confidence: 99%

Pharmacological Therapy of Bronchial Asthma: The Role of Biologicals

Heck¹,

Nguyen

Le³

et al. 2015

Int Arch Allergy Immunol

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Bronchial asthma is a heterogeneous, complex, chronic inflammatory and obstructive pulmonary disease driven by various pathways to present with different phenotypes. A small proportion of asthmatics (5-10%) suffer from severe asthma with symptoms that cannot be controlled by guideline therapy with high doses of inhaled steroids plus a second controller, such as long-acting β₂ agonists (LABA) or leukotriene receptor antagonists, or even systemic steroids. The discovery and characterization of the pathways that drive different asthma phenotypes have opened up new therapeutic avenues for asthma treatment. The approval of the humanized anti-IgE antibody omalizumab for the treatment of severe allergic asthma has paved the way for other cytokine-targeting therapies, particularly those targeting interleukin (IL)-4, IL-5, IL-9, IL-13, IL-17, and IL-23 and the epithelium-derived cytokines IL-25, IL-33, and thymic stromal lymphopoietin. Knowledge of the molecular basis of asthma phenotypes has helped, and continues to help, the development of novel biologicals that target a diverse array of phenotype-specific molecular targets in patients suffering from severe asthma. This review summarizes potential therapeutic approaches that are likely to show clinical efficacy in the near future, focusing on biologicals as promising novel therapies for severe asthma.

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“…Tacrolimus [91], azathioprine [92, 93] and auranofin [94] are other drugs that have been reported to be useful in the treatment of severe asthma. However, sufficient data is not available to affirm their safety and efficacy.…”

Section: Pharmacotherapymentioning

confidence: 99%

State of the art paper Therapeutic options for severe asthma

Mathew¹,

Aronow²,

Chandy³

2012

aoms

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As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidities like gastro-esophageal reflux disease and obstructive sleep apnea. Current treatment options include conventional agents such as inhalational corticosteroids, long acting β2 agonists, leukotriene antagonists, and oral corticosteroids. Less conventional treatment options include immunotherapy with methotrexate, cyclosporine and tacrolimus, biological drugs like monoclonal antibodies, tumor necrosis factor-α blockers and oligonucleotides, phosphodiesterase inhibitors, antimicrobials and bronchial thermoplasty.

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Azathioprine as an oral corticosteroid sparing agent for asthma

Cited by 28 publications

References 8 publications

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

Pharmacological Therapy of Bronchial Asthma: The Role of Biologicals

State of the art paper Therapeutic options for severe asthma

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