Steroids in Asthma: Friend or Foe

Mahboub, Bassam; Mayank, Vats

doi:10.5772/50536

Cited by 3 publications

(3 citation statements)

References 59 publications

(37 reference statements)

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“…Furthermore, SNEA patients used high doses of inhaled steroids that might affect the functions of eosinophils; however, there are no precise data about inhaled steroids transition to circulation and direct effect to blood cells. Inhaled steroids reduce the activity of T cells and bronchial epithelial cells, as well as their released pro-inflammatory mediators that can activate the eosinophils [38,39]. Steroid anti-inflammatory effect is found to reduce eosinophils survival [40] and peripheral blood counts; however, severe asthmatics are only limited affected [41] and are described as steroid resistant.…”

Section: Discussionmentioning

confidence: 99%

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Januškevičius

Jurkevičiūtė

Janulaitytė

et al. 2020

Cells

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Eosinophils subtypes as lung-resident (rEOS) and inflammatory (iEOS) eosinophils are different in surface protein expression, functions, response to IL-5 and localization in lungs. rEOS- and iEOS-like eosinophils are found in blood; thus, we aimed to investigate their quantity and survivability in asthma patients. A total of 40 individuals were included: 10 steroid-free non-severe allergic asthma (AA), and 18 severe non-allergic eosinophilic asthma (SNEA) patients, the control group consisted of 12 healthy non-smoking subjects (HS). A bronchial challenge with Dermatophagoides pteronysinnus allergen was performed for AA patients and HS. Blood eosinophils subtyping was completed with magnetic beads’ conjugated antibodies against surface CD62L. Eosinophils adhesion to hTERT airway smooth muscle (ASM) cells was measured by evaluating their peroxidase activity and viability by annexin V and propidium iodide staining. We found that the predominant blood eosinophil subtype in AA patients was iEOS, while rEOS prevailed in SNEA patients (p < 0.05). Moreover, rEOS demonstrated higher adhesion intensity compared with iEOS in all investigated groups. Both eosinophils subtypes of SNEA patients had higher survivability over the AA group. However, iEOS survivability from AA and SNEA groups was higher compared with rEOS under standard conditions, when rEOS survivability increased after their incubation with ASM cells. Bronchial allergen challenge abolished the dominance of blood iEOS in AA patients and prolonged only iEOS survivability. Though the challenge did not affect the adhesion of any eosinophils subtypes, the direct dependence of rEOS and iEOS survivability on their interaction with ASM cells was revealed (p < 0.05). These findings provide the premise for eosinophils subtype-oriented asthma treatment.

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Section: Discussionmentioning

confidence: 99%

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Januškevičius

Jurkevičiūtė

Janulaitytė

et al. 2020

Cells

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“…IntechOpen; 2012:569–592. 79 Except fluticasone furoate, which was classified according to the Summary of Product characteristics, based on indicated equivalence to fluticasone propionate. b Emitted doses.…”

Section: Figurementioning

confidence: 99%

The dose of inhaled corticosteroids in patients with COPD: when less is better

Izquierdo¹,

Cosío²

2018

COPD

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BackgroundThe use of inhaled corticosteroids (ICS) in combination with bronchodilators in patients with COPD has been shown to decrease the rate of disease exacerbations and to improve the lung function and patients’ quality of life. However, their use has also been associated with an increased risk of pneumonia.Materials and methodsWe have reviewed existing clinical evidence on the risks and benefits of ICS in COPD, including large randomized clinical trials, meta-analyses, and clinical reviews.ResultsA large body of evidence supports the clinical benefits of ICS in patients with COPD in terms of exacerbations, symptoms, lung function, and quality of life. The incidence of adverse events related to ICS, including pneumonia, varies strongly among the studies and seems to be dose dependent, with recent well-designed, large studies on low-dose ICS reporting similar safety profiles in ICS and non-ICS groups.ConclusionThe benefits of ICS in COPD continue to outweigh the risks, especially when lower ICS doses are employed. Given that the data on ICS withdrawal in COPD are scarce and conflicting, we argue that using reduced doses of ICS could be an optimal strategy to manage patients with COPD.

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“…Patients were classified using the daily dose of ICS (high, medium, low) according to the Bassan criteria. 23 …”

Section: Methodsmentioning

confidence: 99%

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

García¹,

Vallejo-Aparicio²,

Ismaila³

et al. 2022

COPD

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Purpose To determine the clinical and economic impact of inhaled corticosteroid (ICS) withdrawal in Spanish patients with COPD receiving triple therapy (TT) with ICS, long-acting β 2 -agonist (LABA), and long-acting muscarinic antagonist (LAMA). Patients and Methods This was an observational, retrospective study of BIG-PAC database medical records. Patients aged ≥40 years receiving TT from 2016 to 2018 were followed for 1 year. Two cohorts were identified: patients continuing TT (ICS+LABA+LAMA), and patients receiving TT with ICS withdrawn (LABA+LAMA). Variables included medication, exacerbations (moderate and severe), pneumonia, mortality, health resource use (HRU), and cost per patient/year. Cohorts were compared using propensity score matching (PSM). Multivariate statistical analysis using analysis of covariance and Cox proportional risks was conducted. Results Of 6541 patients included, 5740 (87.8%) continued TT and 801 (12.2%) had ICS withdrawn. Patients with ICS withdrawal were younger, had lower disease burden, higher ICS doses, and more exacerbations compared with those continuing ICS. PSM matched 795 patients in each cohort. Mean age was 68.5 years (SD: 11.2), 69.9% were male, and mean Charlson index was 2.0. Patients with ICS withdrawal had more total exacerbations in the 12 months following withdrawal compared with patients continuing TT (36.6% vs 31.4%; p=0.030). No significant differences were found for pneumonia (3.3% vs 3.6%; p=0.583) and mortality (9.9% vs 7.5%; p=0.092). Median time to first exacerbation was shorter in patients with ICS withdrawal compared with those continuing ICS (HR: 0.69, 95% CI: 0.57–0.83; p<0.001). Mean health cost per patient/year among patients with ICS withdrawal was higher than those continuing TT (€2993 vs €2130; p<0.001). Conclusion ICS withdrawal in patients with COPD receiving TT was associated with increased exacerbations, HRU, and costs compared with continuing TT, with health and economic impacts on patients and the Spanish National Healthcare System, respectively. Pneumonia and mortality rates were similar between groups.

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Steroids in Asthma: Friend or Foe

Cited by 3 publications

References 59 publications

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

The dose of inhaled corticosteroids in patients with COPD: when less is better

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

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