Intramuscular triamcinolone acetonide in chronic severe asthma.

McLeod, D T; Capewell, Simon; Law, Jennifer; MacLaren, Walter R.; Seaton, A

doi:10.1136/thx.40.11.840

Cited by 35 publications

(4 citation statements)

References 9 publications

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“…Although the exact pharmacokinetic potency of triamcinolone versus oral prednisolone is unclear, triamcinolone likely has greater affinity for the glucocorticoid receptor because early studies in adults with severe refractory asthma have shown greater treatment efficacy with a single 80-mg dose of triamcinolone dose than with a 10-mg dose of prednisolone daily. 45,46 The dose of triamcinolone used in this study was based on previous reports of feasibility and efficacy in children with a similar dosing strategy. 47,48 The 2-week time point that was used for outcome assessment was based on previous studies in adults with severe refractory asthma that demonstrated no clinically meaningful differences between 2 versus 4 weeks of triamcinolone treatment 45 and significant improvement in symptoms, lung function, and airway eosinophils (with almost complete eosinophil disappearance) after only 2 weeks postadministration.…”

Section: Discussionmentioning

confidence: 99%

Systemic Corticosteroid Responses in Children with Severe Asthma: Phenotypic and Endotypic Features

Fitzpatrick

Stephenson

Brown

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

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BACKGROUND Severe asthma in children is a heterogeneous disorder associated with variable responses to corticosteroid treatment. Criterion standards for corticosteroid responsiveness assessment in children are lacking. OBJECTIVE This study sought to characterize systemic corticosteroid responses in children with severe asthma after treatment with intramuscular triamcinolone and to identify phenotypic and molecular predictors of an intramuscular triamcinolone response. METHODS Asthma-related quality of life, exhaled nitric oxide, blood eosinophils, lung function, and inflammatory cytokine and chemokine mRNA gene expression in peripheral blood mononuclear cells were assessed in 56 children with severe asthma at baseline and 14 days after intramuscular triamcinolone injection. The Asthma Control Questionnaire was used to classify children with severe asthma into corticosteroid response groups. RESULTS Three groups of children with severe asthma were identified: controlled severe asthma, children who achieved control after triamcinolone, and children who did not achieve control. At baseline, these groups were phenotypically similar. After triamcinolone, discordance between symptoms, lung function, exhaled nitric oxide, and blood eosinophils was noted. Clinical phenotypic predictors were of limited utility in predicting the triamcinolone response, whereas systemic mRNA expression of inflammatory cytokines and chemokines related to IL-2, IL-10, and TNF signaling pathways, namely, AIMP1, CCR2, IL10RB, and IL5, strongly differentiated children who failed to achieve control with triamcinolone administration. CONCLUSIONS Systemic corticosteroid responsiveness in children with severe asthma is heterogeneous. Alternative prediction models that include molecular endotypic as well as clinical phenotypic features are needed to identify which children derive the most clinical benefit from systemic corticosteroid step-up therapy given the potential side effects.

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Section: Discussionmentioning

confidence: 99%

Systemic Corticosteroid Responses in Children with Severe Asthma: Phenotypic and Endotypic Features

Fitzpatrick

Stephenson

Brown

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

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“…Impairment in the adrenopituitary axis was noted in 23% of the patients given intramuscular TA and they recovered only 2 months after withdrawal. McLeod et al [27] compared TA 80 mg i.m. every 4 weeks to daily oral prednisone 10 mg in the treatment of asthma.…”

Section: Discussion and Reviewmentioning

confidence: 99%

Kaposi’s Sarcoma after Long-Acting Steroids: Time until Remission and Drug Washout

et al. 2010

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Long-acting steroids (LAS) are widely used to treat various inflammatory diseases and allergies. They have many adverse effects including the inhibition of the hypothalamopituitary axis that can last several months. LAS are also strong immunosuppressors and can result in severe opportunistic infections and immunodeficiency-related malignancies. However, the time needed for immune recovery after withdrawal of LAS is unknown. Here we report a case of Kaposi’s sarcoma (KS) and severe immunosuppression after a chronic triamcinolone acetonide (TA) treatment. Six months after withdrawal, traces of TA were still detected in the serum by HPLC mass spectrometry. At 8 months, the drug became undetectable, and clinical and biological signs of immune recovery – beginning of KS regression, normalization of IgG levels and CD4 T lymphocyte counts – became noticeable. We then provide a review of the literature on the time until remission of KS after immunosuppression reduction. We also reviewed the cases of KS induced by TA, and the metabolic side effects of TA when compared to standard glucocorticoids.

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“…Initial studies that investigated individuals with severe asthma generally considered it to be a lack of effect of oral steroids on symptoms or exacerbation rates , or to the presence of fixed airflow obstruction . Symptoms and a consideration of fixed airflow obstruction also formed the basis of the initial National Asthma Education and Prevention Program (NAEPP) classification of asthma severity .…”

Section: Evolution Of the Definition Of Severe Asthmamentioning

confidence: 99%

What is severe asthma?

Blakey

Wardlaw

2012

Clin Experimental Allergy

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Asthma is common, and some individuals are severely affected by it. Learned institutions have sought to provide a definition of 'severe asthma' to facilitate research and clinical care. This is a challenging undertaking given the difficulty in defining asthma and the lack of supportive evidence for a distinct severe asthma phenotype. In this review, we discuss the rationale for a definition of severe asthma and the relative merits of the sequential attempts that have been made to produce such a definition. The difficulty in disentangling control and severity is highlighted, as is the heterogeneity of phenotype in severe asthma, and potential for misclassification. We conclude that the search for a singular definition of severe asthma is problematic, though likely to continue. We suggest the alternative strategy of using classifiers with a specific aim related to symptoms, pathophysiology or service provision.

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Intramuscular triamcinolone acetonide in chronic severe asthma.

Cited by 35 publications

References 9 publications

Systemic Corticosteroid Responses in Children with Severe Asthma: Phenotypic and Endotypic Features

Systemic Corticosteroid Responses in Children with Severe Asthma: Phenotypic and Endotypic Features

Kaposi’s Sarcoma after Long-Acting Steroids: Time until Remission and Drug Washout

What is severe asthma?

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