Posts Tagged ‘corticosteroids’

There is no difference in terms of major disease factors among patients suffering from cystic fibrosis (CF) receiving inhaled corticosteroids and those who do not.

Disease factors consist of the number of prescribed antibiotics, lung function decline, and onset time of acute chest exacerbation or frequency of using a bronchodilator.

From News-Medical.Net:

“Oral corticosteroids slow the progression of CF lung disease, but long-term use is precluded by unacceptable side effects,” said Dr. Balfour-Lynn. “A systematic review of inhaled corticosteroid use in CF revealed 10 randomized controlled trials, with six having been published. The trials studied 293 adults and children. Although there was variable methodological quality among the studies, the conclusion was that there was ‘no evidence from existing trials to support the practice of prescribing inhaled steroids in cystic fibrosis.’”

The authors noted that 52 percent of the patients were on high-dose inhaled corticosteroids (1,000 micrograms or more per day). At those levels, the drug can lead to significant symptoms related to adrenal suppression and insufficiency. Also, among pediatric patients, slowing of linear growth has been a problem for individuals taking the drug for a year or more.

Ian M. Balfour-Lynn, M.D., F.R.C.P., of the Department of Pediatric Respiratory Medicine at Royal Brompton Hospital in London, and six associates, concluded that patients can stop making the use of inhaled corticosteroids for reducing drug burden and to reduce potential adverse side effects.

Patients with chronic obstructive pulmonary disease (COPD) and using inhaled corticosteroids face a reduced mortality risk, as per a new study published in the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).

The research revealed that patients who were administered with inhaled corticosteroids within a period of one month of hospital discharge noticed reductions of 25 and 38 percent in terms of all-cause mortality rate and cardiovascular-related deaths in patients using steroids paired with beta-agonists, respectively.

From News-Medical.Net:

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Author Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada, said that the study evaluated the effects of corticosteroids and was endorsed by resulting highlighting that survival is longer in patients using inhaled corticosteroids.

The potential risk of an asthma attack relapse can be reduced to a significant extent by administering a short corticosteroid course after patients are discharged from the hospital, according to a Cochrane Systematic Review.

Carol Spooner, a colleague, said that this systematic review strongly endorses the use of systematic corticosteroids for treating outpatients after getting them discharged from the hospital on the event of an attack.

From News-Medical.Net:

This updated finding was drawn after reviewing data in six trials that together involved 374 people.

Between 12% and 16% of people who are discharged from hospital after having an asthma attack have a relapse within two weeks. “There is considerable debate about the best way of treating people who have asthma attacks, including the dose, method of delivery and timing of delivery of corticosteroids. Our research found clear evidence that people who arrived at a hospital with acute asthma and were well enough to be discharged benefited from the addition of corticosteroid therapy,” says lead author Professor Brian Rowe, who works at the University of Alberta, in Edmonton, Canada.

It was also noted that administration of steroids is also useful for reducing need of inhalers besides prolonging related benefits for a period of three weeks.

Adult and young asthmatic patients can benefit more from inhaled corticosteroids than with cromolyn. This finding was revealed in a review of studies comparing inhaled corticosteroids and cromolyn.

It was remarked by James Guevara, M.D., of the University of Pennsylvania School of Medicine and colleagues, that asthmatic patients on steroids tend to experience average three fewer severe asthma flare-ups each year, scored better on lung function tests, and make lesser use of inhalers than their counterparts on cromolyn.

From News-Medical.Net:

“Any expert would agree that inhaled corticosteroids are preferred first-line therapy for treatment of persistent asthma, which requires daily therapy. But we also will agree with the NIH [National Institutes of Health] asthma guidelines, which state that cromolyn and other drugs are alternative therapies,” Storms said.

Cromolyn, or sodium cromoglycate, and inhaled corticosteroids both block the action of certain inflammatory cells in the lungs. Physicians recommend both types of medication for persistent asthma, but individual studies disagree about which type of medication works best, the reviewers found.

“The safety of sodium cromoglycate has been well established, but the effectiveness of sodium cromoglycate in controlling asthma symptoms may be limited,” Guevara said, adding that the lack of effective control might be one reason cromolyn has fallen out of favor compared to inhaled corticosteroids since the 1990s.

William Storms, M.D., an allergist at the University of Colorado Health Sciences Center and director of the William Storms Allergy Clinic in Colorado Springs, remarked that this consensus does not mean that there is no room for cromolyn treatment.

Members of the medical fraternity need to exercise greater caution while recommending inhaled corticosteroids to people with COPD (chronic obstructive pulmonary disease), as per Lung disease experts at Johns Hopkins.

This call for caution was made after it was found that some of the presently used anti-inflammatory medications increase the risk of pneumonia by a full third.

Almost 11 million Americans on a yearly basis are suffering from COPD and most of them belong to the category of present or former smokers.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

Lead author of this study, pulmonologist M. Brad Drummond, M.D., M.H.S., was of the view that this finding will serve as a reminder to the doctors and patients with severe lung disease to plan and take steps for reducing the risk of pneumonia that doubles the risk of death.

Dexamethasone treatment, a common steroid-based treatment, is ineffective for children with bronchiolitis when it comes to provide any relief in terms of improving symptoms or reducing hospitalization incidents, as per a recent research.

This research appeared in an issue of the New England Journal of Medicine. Prashant Mahajan, M.D., M.P.H, M.B.A, DMC Children’s Hospital vice chief of pediatric emergency medicine and associate professor of pediatrics and emergency medicine at Wayne State University School of Medicine was a lead co- investigator in the nationwide study involving 600 kids aged two to twelve months.

From News-Medical.Net:

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. Hospital charges associated with the disease exceed $700 million annually. According to Dr. Mahajan, prescribing dexamethasone is a common practice among emergency room physicians and pediatricians to treat acute bronchiolitis. “Corticosteroids are commonly used to treat bronchiolitis although evidence of their effectiveness is limited.” The findings of this study resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.

Given the results of this study, though there is really no best treatment for children, researchers now can concentrate on finding better treatment and better preventative strategies.

Study lead investigators noted that glucocorticoid medications, not like androgenic steroids that are often abused by athletes, can play a crucial role in in other respiratory complications of the childhood, such as coup and asthma.

Researchers at the Queen Mary University London and the University of Leicester have identified a potential breakthrough for treating a rare but life-endangering complication that affects young people and children.

Dr Marcus Cooke, Senior lecturer in the Radiation and Oxidative Stress Section at the University of Leicester remarked that oxidative stress has the potential of making a significant difference in the quality of life of an individual.

This preliminary data was published as a letter in the New England Journal of Medicine.

From News-Medical.Net:

Dr Cooke said that idiopathic pulmonary haemosiderosis is a devastating condition. Characteristic of this condition is the accumulation of protein-bound iron in the lungs, a consequence of repeated bleeding in the lungs, coupled with inflammation and fibrosis. Ultimately this condition is usually fatal. Treatment to prevent the lung damage and prevent anaemia is a combination of corticosteroids and iron supplement.

Both chronic inflammation, and the presence of iron, released following bleeding into the lungs, can lead to a condition known as oxidative stress. Oxidative stress occurs when the production of free radicals, highly reactive chemicals, outweighs antioxidant defences. This leads to a great deal of damage to cells, and in particular DNA, the cell’s blueprint, and is likely to be responsible for the fibrosis, as the lungs try to repair the damage done by free radicals.

“In order to establish whether oxidative stress was indeed associated with episodes of bleeding into the lungs, we measured a biomarker of oxidative stress, and a marker of damage to DNA specifically, in urine.

Jonathan Grigg, Professor of Paediatric Respiratory and Environmental Medicine at Queen Mary University London, said that enhanced oxidative stress may be effectively treated by using antioxidant, N-acetyl cysteine – which has no side effects.

The long-term use of a macrolide antibiotic can significantly reduce the frequency of exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD) by as much as thirty-five percent, as per a London-based study.

It was remarked by lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator, that the results show a significant effect of low-dose macrolide therapy, reducing exacerbation frequency and severity with moderate to severe COPD.

From News-Medical.Net:

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

This groundbreaking study’s results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine that is published by the American Thoracic Society. The study is the first-ever year-long randomized, double-blind, placebo-controlled study of the effects of erythromycin in chronic obstructive pulmonary disease (COPD).

Children with asthma and being administered with steroids in the younger age but discontinuing the usage after some time may not experience the same benefits as with steroid usage, according to results from a comprehensive childhood asthma study.

This study finding came from the Childhood Asthma Management Program (CAMP) clinical trial that involved more than 1,000 children with mild-to-moderate asthma. These children were divided into three groups of which one received placebo, second one received nedocromil (an inhaled non-steroid medication), and the third one received twice-daily budesonide and an inhaled corticosteroid. All the participating groups also received albuterol, a bronchodilator, and oral corticosteroids for treating asthma symptoms.

From News-Medical.Net:

Inhaled corticosteroids such as budesonide have been shown to be the most effective form of anti-inflammatory treatment for asthma by controlling symptoms and improving pulmonary function. Results from the original CAMP trial showed that using budesonide twice daily led to fewer hospitalizations and urgent care visits, fewer days in which additional asthma medications were needed and a reduced need for albuterol, a fast-acting drug for relief of acute asthma symptoms. Using nedocromil twice daily reduced urgent care visits and courses of oral steroids for severe symptoms, but did not affect the number of hospitalizations, symptoms or airway responsiveness.

Although the patients had fewer symptoms five years after stopping the daily medication, Strunk cautions that doesn’t mean that they can stop using asthma medications altogether or that their asthma is cured.

The study findings are considered to provide new insights to members of the medical fraternity when it comes to formulation of new asthma treatment plans.

Young male patients with muscular dystrophy can expect to attain benefits with a daily treatment with steroids, as per a study supported by the General Clinical Research Center at the Ohio State University and the National Center of Research Resources of NIH.

It was suggested that boys with MD can walk for longer and on their own (without any assistance) by getting themselves administered with steroids on a daily basis. Wendy King, a physical therapist in the neurology department at Ohio State University remarked that the risks of scoliosis and curvature degree can also be reduced considerably with daily corticosteroid treatment.

From Medpagetoday.com:

The reason for non-treatment with steroids was invariably parent refusal because of fear of side effects, the researchers said. The average duration of steroid use was 8.04 years.

The study found:

* Boys on steroids were able to walk independently, on average, 3.3 years longer than those who weren’t treated. The difference — from 9.21 years to 12.52 years — was significant at P<0.0001.

* The prevalence of scoliosis in the treated boys was 31%, compared with 91% among those not getting steroids, a difference that was significant at P<0.0001.

* The average scoliotic curve was 11.6 degrees in the treated boys, compared with 33.2 degrees in the untreated boys, which was also significant at P<0.0001.

* On the other hand, 32% of the treated boys had vertebral compression fractures versus none in those not getting steroids, which was significant at P<0.0012.

* The yearly long-bone fracture rate was 0.088 among the treated boys, but only 0.033 in the untreated group, difference by a factor of 2.6, which was significant at P<0.0032.

Several factors probably play a role in the increased rate of long-bone fractures, the researchers said, including prolonged independent walking and increased body weight because of the steroids.

It was also suggested that calcium supplements must be administered to boys with muscle atrophy and regular medical examination must be followed due to orthopedic implications of steroids use.