The use of cyclosporin in corticosteroid dependent asthma

Coren, ME; Rosenthal, Martin C.; Bush, Andrew

doi:10.1136/adc.77.6.522

Cited by 54 publications

(23 citation statements)

References 7 publications

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“…In a later study, treatment of 16 adults with cyclosporin for 36 weeks resulted in a significant reduction in prednisolone usage compared to placebo, as well as an improvement in lung function (73). No trials have been carried out on children, although there is a case report of its use in five children on regular oral steroids, three of whom experienced a definite benefit (74). The side effects in adults include hirsutism, paresthesia, mildhypertension, headaches, and tremor (72,73).…”

Section: Oral Cyclosporinmentioning

confidence: 96%

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: Oral Cyclosporinmentioning

confidence: 96%

Children with Difficult Asthma: A Practical Approach

Payne¹,

Balfour‐Lynn²

2001

Journal of Asthma

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“…Cyclosporin A has been used in adults and children with asthma. 43,44 We have used aurano®n, 45 while others have used methotrexate. 46 Side effects with these latter three drugs, particularly at the beginning of therapy, are common.…”

Section: Cs Responsementioning

confidence: 99%

Difficult asthma: Defining the problems

et al. 2001

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“…There have been no new randomised trials since the review. One paediatric case series reported benefit in terms of OCS reduction in three out of five children [108]. Whether in the future nebulised cyclosporin may be beneficial with fewer side-effects is an important unanswered question [109,110].…”

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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The use of cyclosporin in corticosteroid dependent asthma

Cited by 54 publications

References 7 publications

Children with Difficult Asthma: A Practical Approach

Children with Difficult Asthma: A Practical Approach

Difficult asthma: Defining the problems

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

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