Corticosteroid unresponsiveness in asthma: Primary or acquired?

Payne, Donald; Hubbard, Melissa; McKenzie, S A

doi:10.1002/(sici)1099-0496(199801)25:1<59::aid-ppul7>3.0.co;2-j

Cited by 23 publications

(8 citation statements)

References 9 publications

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“…In these situations other treatment strategies need to be tried while continuing the steroids at an optimum dose or attempting to reduce the dose. Very rarely, a patient will appear to derive no benefit from steroids (32). If this is suspected, then steroids should be gradually withdrawn and the response carefully documented.…”

Section: Steroid Insensitivitymentioning

confidence: 99%

Children with Difficult Asthma: A Practical Approach

Payne¹,

Balfour‐Lynn²

2001

Journal of Asthma

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Many open studies investigating the effects of innovative treatments for steroid-dependent asthma demonstrate some benefit. This is also true of the majority of placebo arms in placebo-controlled trials. This suggests that children with difficult asthma benefit from the high level of input that is typically provided in clinical trials, with or without additional medication. Such intensive management of patients, with the emphasis on establishing the diagnosis, improving adherence, and identifying provoking factors, is the key to optimizing asthma control for these children. For patients with genuinely severe asthma, despite high doses of conventional treatment, a greater understanding of the pathological basis of persistent symptoms is needed. Identification of different pathological subtypes of severe asthma should allow for more rational prescribing of asthma therapy, as well as the design of further trials of potential steroid-sparing treatments.

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Section: Steroid Insensitivitymentioning

confidence: 99%

Children with Difficult Asthma: A Practical Approach

Payne¹,

Balfour‐Lynn²

2001

Journal of Asthma

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“…Thus, biopsy evidence of steroid‐resistant eosinophilic inflammation in a symptomatic child would support use of an agent such as methotrexate or cyclosporin. On the other hand, a patient whose biopsy shows neutrophilic inflammation might be given a long‐acting β‐agonist or continuous subcutaneous terbutaline 4 , 13 . ‐ 15 This approach may be correct, but the lack of longitudinal data means that its appropriateness in children remains to be established.…”

Section: What Have We Discovered?mentioning

confidence: 99%

Invasive monitoring of airway inflammation

Henry

2002

Medical Journal of Australia

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“…Steroid-resistant asthma can also occur, although it is uncommon [7,85]. In such cases, asthma symptoms do not improve satisfactorily even with systemic steroid therapy due to a defect at the level of the steroid receptor.…”

Section: Current Treatments: Bene®ts and Limitationsmentioning

confidence: 99%