Cyclosporin as an oral corticosteroid sparing agent in stable asthma

Evans, David; Cullinan, Paul; Geddes, Duncan M.; Walters, E. Haydn; Milan, Stephen J; Jones, Paul

doi:10.1002/14651858.cd002993

Cited by 52 publications

(44 citation statements)

References 10 publications

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“…Evidence is lacking for the use of so-called steroidsparing agents, such as azathioprine, chloroquine, cyclosporine, gold, and methotrexate. [28][29][30][31][32] However, add-on therapies, such as macrolides, anti-immunoglobulin E, tumor necrosis factor alpha inhibitors, cytokine receptor antagonists, and bronchial thermoplasty, are developing as alternative options in refractory asthma care. 33,34 Inhaled Versus Systemic Route of Short-Acting ␤-Agonist Administration According to the latest global strategy for asthma management and prevention report of the Global Initiative for Asthma, asthma treatment for adults is divided into controller and reliever categories, each administered via inhalation, orally, or parenterally (subcutaneous, intramuscular, or intravenous injection).…”

Section: Discussion Current Evidence-based Asthma Management and Carementioning

confidence: 99%

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

2015

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INTRODUCTION:Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway. METHODS: This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment. RESULTS: Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P ‫؍‬ .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P ‫؍‬ .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S pO 2 increased at 5 min post-treatment with ELB. In contrast, S pO 2 decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P ‫؍‬ .92) and ELB conditions (P ‫؍‬ .18). CONCLUSIONS: ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI. Key words: albuterol liquid bolus; albuterol lavage; novel use albuterol. [Respir Care 2015;60(5):627-635.

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Section: Discussion Current Evidence-based Asthma Management and Carementioning

confidence: 99%

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

2015

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“…Therefore, tapering oral glucocorticosteroids to the lowest effective dose is of high priority [69]. Classical steroid sparing treatments including oral gold [71], methotrexate [72] and ciclosporin [73] have not gained acceptance because of limited effects and significant side-effects.…”

Section: Phenotype-specific Treatmentmentioning

confidence: 99%

Severe refractory asthma: an update

Wener

Bel

2013

Eur Respir Rev

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Asthma is a heterogeneous disease in which adequate asthma control cannot be achieved in a substantial proportion despite currently available treatment possibilities. This subgroup has been defined as ''severe refractory'' asthma. Over the past years considerable progress has been made regarding a more exact definition of severe refractory asthma. A systematic approach to evaluate the asthma patient has been postulated. Further detailed classification into distinct phenotypes is ongoing to target the right treatment to the right patient. And, new therapeutic targeted treatment options are currently in development to provide possible new targets to improve disease state, symptoms and quality of life. This review will provide an update on the latest advancements with regard to all these domains. @ERSpublications Phenotyping the severe asthma patient is essential to ensure the right treatment is given to the right patient

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“…More data are needed to establish whether other groups may also benefit. Cyclosporin A Cochrane review [107] identified three adequate trials of cyclosporin in 106 adults with steroid-dependent asthma (98 patients analysable). There was a very small effect on steroid reduction, of questionable significance.…”

Section: Recommendationsmentioning

confidence: 99%

Pharmacological treatment of severe, therapy-resistant asthma in children: what can we learn from where?

Bush

Pedersen²,

Hedlin³

et al. 2011

Eur Respir J

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There is a lack of high-quality evidence on what treatment should be used in children with properly characterised severe, therapy-resistant asthma. Data have to be largely extrapolated from trials in children with mild asthma, and adults with severe asthma. Therapeutic options can be divided into medications used in lower doses for children with less severe asthma, and those used in other paediatric diseases but not for asthma (for example, methotrexate). In the first category are high-dose inhaled corticosteroids (ICS) (f2,000 mg?day -1 fluticasone equivalent), oral prednisolone, the anti-immunoglobulin (Ig)E antibody omalizumab, high-dose long-acting b 2 -agonists, low-dose oral theophylline and intramuscular triamcinolone. If peripheral airway inflammation is thought to be a problem, the use of fine-particle ICS or low-dose oral corticosteroids may be considered. More experimental therapies include oral macrolides, cyclosporin, cytotoxic drugs such as methotrexate and azathioprine, gold salts, intravenous infusions of Ig, subcutaneous b 2 -agonist treatment and, in those sensitised to fungi, oral antifungal therapy with itraconazole or voriconazole. Those with recurrent severe exacerbations, particularly in the context of good baseline asthma control, are particularly difficult to treat; baseline control and lung function must be optimised with the lowest possible dose of ICS, and allergen triggers and exposures minimised. The use of high-dose ICS, leukotriene receptor antagonists or both at the time of exacerbations can be considered. There is no evidence regarding which therapeutic option to recommend. Better evidence is required for all these treatment options, underscoring the need for the international and co-ordinated approach which we have previously advocated.

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Cyclosporin as an oral corticosteroid sparing agent in stable asthma

Cited by 52 publications

References 10 publications

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction

Severe refractory asthma: an update

Pharmacological treatment of severe, therapy-resistant asthma in children: what can we learn from where?

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