Effect of oral prednisone on airway inflammatory mediators in atopic asthma.

Dworski, Ryszard; Fitzgerald, Garrett; Oates, John A.; Sheller, James R.

doi:10.1164/ajrccm.149.4.8143061

Cited by 266 publications

(162 citation statements)

References 25 publications

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“…It is worth noting that montelukast possessed similar inhibitory effect on samples from asthmatics irrespective of whether they were or not currently treated with inhaled corticosteroids. This goes in line with the documented inability of corticosteroids to adequately control the release of cysteinyl-leukotrienes in the airways of asthmatics (16). The extent of inhibition obtained in our study is slightly lower than that achieved with a specific monoclonal antibody directed towards eotaxin which was shown to range from 52% to 86% inhibition in moderate to severe asthma (17).…”

Section: Discussionsupporting

confidence: 87%

Cysteinyl‐leukotrienes contribute to sputum eosinophil chemotactic activity in asthmatics

Hemelaers

Henket

Sele

et al. 2005

Allergy

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Background: Cysteinyl-leukotrienes are lipid derived mediators involved in asthma. They are able to stimulate eosinophil chemotaxis in vitro. Induced sputum from asthmatics has been shown to contain eosinophil chemotactic activity. The purpose of our study was to evaluate the contribution of cysteinyl-leukotrienes to sputum eosinophil chemotactic activity in asthmatics and to seek whether there might be differences between asthmatics free of inhaled corticosteroids vs those regularly receiving this treatment. Methods: Twenty-two patients (11 corticosteroid free, mean FEV 1 99% predicted, 11 corticosteroid-treated, mean FEV 1 77% predicted) recruited from our asthma clinic underwent a sputum induction. Sputum was processed according to standard procedure. Eosinophil chemotactic activity contained in the fluid phase was assessed using Boyden microchamber model and expressed as chemotaxis index (CI). Cysteinyl-leukotrienes were measured in sputum supernatant by ELISA and their role in sputum eosionophil chemotactic activity was evaluated by using montelukast, a selective antagonist of a cys-LT1 receptor. Results: Cysteinyl-leukotrienes were well detectable in sputum supernatants from both steroid-naive (247 ± 42 pg/ml) and steroid-treated (228 ± 26 pg/ml) asthmatics. Sputum eosinophil chemotactic activity was indiscriminately present in both corticosteroid-naive (CI: 2.61 ± 0.22) and corticosteroid-treated (2.98 ± 0.35) asthmatics. Montelukast (100 µM) significantly inhibited the eosinophil chemotactic activity in both groups achieving a mean inhibition of 54.2 ± 9.2% (P < 0.001) and 64.7 ± 7.8% (P < 0.001) in steroid-naive and steroid-treated asthmatics respectively. Conclusion: Cysteinyl-leukotrienes actively participate in sputum eosinophil chemotactic activity found in asthmatics irrespective of whether they are or not under treatment with inhaled corticoids.

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Section: Discussionsupporting

confidence: 87%

Cysteinyl‐leukotrienes contribute to sputum eosinophil chemotactic activity in asthmatics

Hemelaers

Henket

Sele

et al. 2005

Allergy

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“…67 Mucous production is decreased, and inflammatory cell infiltration and activation are reduced. 68,69 In children with severe acute asthma, systemic corticosteroids are indicated and in the intensive care unit (ICU) setting the intravenous route is preferred. 70 Methylprednisolone is a widely used agent because of its limited mineralocorticoid effect.…”

Section: Steroidsmentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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“…For example, subjects treated even with high doses of glucocorticosteroids excreted significant quantities of leukotrienes and prostanoids in their urine [178,179]. The results of these and additional studies [180,181] in asthmatics provide the perhaps surprising conclusion that there is no significant inhibitory effect of even chronic systemic treatment with oral prednisone or inhaled fluticasone proprionate on the in vivo formation of leukotrienes in humans. The much acclaimed hypothesis that glucocorticosteroids inhibit eicosanoid formation in vivo is clearly obsolete.…”

Section: Pharmacological Control Of the Leukotriene Pathwaymentioning

confidence: 99%