Interaction of corticosteroids and catecholamines in the treatment of asthma.

Shenfield, Gillian M.; Hodson, Margaret E.; Clarke, S W; Paterson, J. W.

doi:10.1136/thx.30.4.430

Cited by 59 publications

(14 citation statements)

References 21 publications

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“…The dangers of withdrawing systemic corticosteroids from severe asthmatics after their long-term use are well known. Severe attacks of asthma are particularly likely to occur following 'weaning' from these drugs (Maunsell et al, 1968 (Shenfield et al, 1975 (Dunnill, 1971). However, in the United States a number of reports have underlined the frequent presence of inflammation in the tracheobronchial tree, including bronchopneumonia, in children dying from asthma (Buranakul et al, 1974;Richards and Patrick, 1965 and 2) had the typical necropsy findings described by Fraser et al (1971) and did not have acute inflammatory changes in the lungs.…”

Section: Methodsmentioning

confidence: 99%

Asthma deaths in children--a continuing problem.

Mellis¹,

Phelan²

1977

Thorax

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Section: Methodsmentioning

confidence: 99%

Asthma deaths in children--a continuing problem.

Mellis¹,

Phelan²

1977

Thorax

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“…Besides, the glucocortiasthmatic subjects with either placebo, 250, 500 coids seem able to potentiate the action of betaor 1000 mg hydrocortisone intravenously, fol-adrenergic agents. It is a common clinical oblowed by inhalation of isoprenaline at hourly servation that the severely affected asthmatic intervals for 6 h. No difference was found in patient who does not respond to the beta agothe course of the four groups, who were fol-nists, may regain responsiveness during glucolowed with measurements of forced expiratory corticoid treatment (3,34,120). Normal subjects volumes and of airway resistance and conduct-with an induced resistance to beta agonists may ance in a body plethysmograph.…”

Section: Intravenous Aminophylline and Intravenousmentioning

confidence: 99%

“…Yet we do not understand hypoxaemia (107). The average heart rate is what happens when the patient lapses into about [120][121][122][123][124][125][126][127][128][129][130] found an average status asthmaticus despite the use of the medi-rate of 126; Westerman (137) 139 with a range cation which in other situations has successfully from 110 to 180; Rees (107) 118, range 96-160. brought him relief Cooke et al (25) found a heart rate above 90 in 87% of their patients and that 75% of the complications occurred in patients with a heart Objective assessment ^ , ,0•^ rate above 130. The treatment of severe asthma must reasonTwo important objective measurements that ably begin with an assessment of severity.…”

mentioning

confidence: 99%

The Treatment of Status Asthmaticus

Georg

1981

Allergy

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Asthma has proved difficult to define (42, 103, in asthma often comes suddenly and unexpect-116) and physicians do not always agree about edly, and even experienced physicians may when a patient should be called asthmatic, have difficulty in judging the severity of an Status asthmaticus cannot be easier to define, attack. The patient may be a better judge in but it seems much more seldom that physicians this respect (122), but many asthmatics are not disagree about a diagnosis of status asthma-very sensitive to changes in airway obstruction, ticus. The term will be used here to denote a Rubinfeld & Pain (111) found that 15% were sustained attack of severe asthma that has not unable to sense a reduction in FEVj below 50% responded to the treatment administered by of predicted value. An objective assessment the patient and his doctor. It is a serious and ought usually to be the first step taken when potentially lethal phase of the disease and if dealing with a patient in status asthmaticus. It hospital admission is possible it will usually be can be carried out in a few minutes, and it required.provides both a baseline from which the proStatus asthmaticus is an acute aggravation gress of the patient can be assessed and a gradwhich may afflict the allergic as well as the ing of the severity of the attack, non-allergic asthmatic. It may occur at any age.The physical signs of wheezing, the use of but the risk seems to be greatest in the middle-accessory respiratory muscles and the presence aged patient with asthma of late onset. It also of pulsus paradoxus have not been found to be seems to afflict women more often than men. reliable indicators of the severity of asthma (71, In seven recent papers (7,25,58,61,70,118,121). 119) out of a total of 1,540 patients, 1,136 were Counting the heart rate is the simplest of females and 404 males, i.e. a ratio of about 3:1.objective measurements and will provide some We have now fairly good knowledge of the indication of the severity of the attack. An elecliberation of mediator substances from the trocardiogram and a chest radiograph should mast cell in the reaction with specific allergens also be available. Tachycardia is always a feature and about their possible significance in acute, of severe asthma and is related to the degree of asthmatic attacks. Yet we do not understand hypoxaemia (107). The average heart rate is what happens when the patient lapses into about [120][121][122][123][124][125][126][127][128][129][130] found an average status asthmaticus despite the use of the medi-rate of 126; Westerman (137) 139 with a range cation which in other situations has successfully from 110 to 180; Rees (107) 118, range 96-160. brought him relief Cooke et al. (25) found a heart rate above 90 in 87% of their patients and that 75% of the complications occurred in patients with a heart Objective assessment ^ , ,0•^ rate above 130. The treatment of severe asthma must reasonTwo important objective measurements that ably begin with an assessment of severity. Death any emergency ward s...

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“…Preparations of pig bronchus are being evaluated currently in our laboratory, as a model of human central airways. We have studied the effects of several steroids on catecholamine-induced relaxation of pig bronchus, with a view to clarifying the possible mechanism of steroid-induced potentiation of catecholamines reported in asthmatics (Shenfield et al, 1975).…”

Section: Introductionmentioning

confidence: 99%

“…Various steroids potentiate the actions of catecholamines both in vivo (Fritz & Levine, 1951;Schmid, Eckstein & Abboud, 1967;Pun, McCulloch & Rand, 1973;Shenfield, Hodson, Clarke & Paterson, 1975;Goldie, 1980) and in vitro (Kalsner, 1969;Kaumann, 1972;Goldie, 1976;Cornish, Goldie & Miller, 1978;Hackney & Szentivanyi, 1980). The underlying mechanism of steroid-induced potentiation of catecholamine responses has been attributed variously to adrenoceptor sensitization (Besse & Bass, 1966;Yard & Kadowitz, 1972;Brine, Cornish & Miller, 1979), inhibition of catecholamine uptake (Kaumann, 1972;Pun et al, 1973;Goldie, 1976) and inhibition of catechol-0-methyl transferase (COMT) (Kalsner, 1969;Cornish & Goldie, 1980).…”

Section: Introductionmentioning

confidence: 99%