Journal of Allergy and Clinical Immunology
Effects of glucocorticoids on lymphocyte activation in patients with steroid-sensitive and steroid-resistant asthma☆,☆☆,★,★★
Section snippets
Subjects
Thirteen patients with a diagnosis of asthma, according to American Thoracic Society criteria, were selected for evaluation. Informed consent was obtained from all patients before entry into the study. Seven patients were classified as having SR asthma on the basis of their prebronchodilator morning FEV 1 of less than 70% of predicted value and failure to improve their morning prebronchodilator FEV 1 by more than 15% after a course of oral prednisone in doses equal to or exceeding 40 mg/day for
Clinical characteristics and the effect of glucocorticoids on lymphocyte proliferation
The mean ages of the study groups were similar, whereas the majority of other characteristics were significantly different. As expected, patients with SR asthma had poorer pulmonary function and were receiving higher doses of inhaled steroids; and six of the seven were receiving maintenance oral steroid therapy (Table I). Patients with SS asthma were significantly more sensitive to the suppressive effects of all glucocorticoids studied compared with those with SR asthma. Fig. 1 compares the
Discussion
The vast majority of patients with asthma respond favorably to glucocorticoid therapy with relief of symptoms, improvement in baseline pulmonary function, and reductions in nonspecific bronchial hyperresponsiveness. Unfortunately, a small subset of patients with severe asthma that fails to adequately respond to high-dose inhaled and long-term oral glucocorticoid therapy exists. These “steroid resistant” asthmatic patients are often the most difficult group of patients with asthma to treat.
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Cited by (0)
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From the Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Divisions of Allergy-Clinical Immunology and Clinical Pharmacology (the Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology in Pediatrics) and the Departments of Pediatrics and Pharmacology, University of Colorado Health Sciences Center, Denver.
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Supported in part by a grant from Astra USA and United States Public Health Service grants HL-36577, and RR-00051. Dr. Szefler is the Helen Wohlberg and Herman Lambert Chair in Pharmacokinetics.
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Reprint requests: Stanley J. Szefler, MD, Department of Pediatrics, The National Jewish Center for Immunology and Respiratory Medicine, 1400 Jackson St., Denver, CO 80206.
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