Posts Tagged ‘corticosteroids’

Corticosteroids may prove to be of little or no use for improving the survival rates in end-stage acute respiratory distress syndrome (ARDS), as per an NIH-sponsored trial.

Steroids may lead to hasten death if given in the condition for more than 13 days, as per the Late Steroid Rescue Study, undertaken by the ARDS Clinical Research Network of the National Heart, Lung, and Blood Institute (NHLBI).

From Earthtimes.org:

The findings of the study appear in the April 20 issue of the New England Journal of Medicine. The study had 180 people with ARDS, who were followed for a week to 28 days. Researchers reported identical death rates in people who received steroids (28.6 percent) and those who did not (29.2 percent). “These findings provide important information to help us determine the safest and most effective ways to care for patients with this devastating condition,” said Elizabeth G. Nabel, MD, Director at NHLBI. “Whether and how to use steroids to treat ARDS patients have been important questions for years. We now have better evidence of the effect of this treatment to help clinicians and patients make more informed decisions.”

The researchers emphasized that future studies are needed before arriving at any conclusions.

Corticosteroids are ineffective for improving survival in patients with late-stage acute respiratory distress syndrome (ARDS), according to results from the ARDS Clinical Research Network of the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

Acute respiratory distress syndrome is a sudden and life-threatening condition that affects approximately 150,000 people annually in the United States alone.

From News-Medical.Net:

There is no specific drug treatment for ARDS. The focus of care is to get enough oxygen into the blood until the lungs are functioning again. Patients are placed in the intensive care unit and supported with mechanical ventilators and fluids. Some patients recover and can breathe on their own within a week or so. Others might need to be on mechanical support to help with breathing for longer periods of time, but they can develop long-term complications from ventilator use or other treatments.

Because ARDS is related to inflammation in the lung, steroids are sometimes used in the hopes of helping the lungs heal. Earlier small or observational studies have suggested that moderate doses of steroids given 7 or more days after the onset of ARDS might improve lung function and increase survival. But a larger randomized clinical trial – considered the gold standard in medical research – was needed to determine whether moderate doses of steroids are beneficial for patients with late-stage ARDS.

NHLBI Director Elizabeth G. Nabel, MD said the findings provide invaluable information for determining the safest yet the most effective ways to treat patients with this devastating condition.

Low levels of vitamin D were found to be linked with minimized lung function and medication use in children with asthma, as per researchers at National Jewish Health.

This finding was revealed in a paper published online this week in the Journal of Allergy & Clinical Immunology.

From Sciencedaily.com:

“Our findings suggest two possible explanations,” said senior author Donald Leung, MD, PhD. “It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Or, it may be that vitamin D directly affects steroid activity, and that low levels of vitamin D make the steroids less effective, thus requiring more medication for the same effect.”

The researchers performed a series of laboratory experiments that indicated vitamin D enhances the action of corticosteroids. They cultured some immune cells with the corticosteroid dexamethasone alone and others with vitamin D first, then dexamethasone. The vitamin D significantly increased the effectiveness of dexamethasone. In one experiment vitamin D and dexamethasone together were more effective than 10 times as much dexamethasone alone.

The researchers also incubated immune-system cells for 72 hours with a staphylococcal toxin to induce corticosteroid resistance. Vitamin D restored the activity of dexamethasone.

“Our work suggests that vitamin D enhances the anti-inflammatory function of corticosteroids,’ said Dr. Leung. “If future studies confirm these findings vitamin D may help asthma patients achieve better control of their respiratory symptoms with less medication.”

Daniel Searing, MD, and his colleagues reported that ability of Vitamin D for enhancing the activity of the most effective controller medication for asthma, corticosteroids.

Corticosteroid nasal sprays are better than antihistamines when used “as needed” to treat seasonal allergies, according to researchers from the University of Chicago.

The finding, which was published in the November 26 issue of the Archives of Internal Medicine, suggested that the current prescription patterns and guidelines flavoring the use of antihistamines to be the first-line treatment option for mild or moderate allergies need to be altered.

From Sciencedaily.com:

Antihistamines can block the actions of histamines if taken in advance but they have no impact on the late response. Intranasal steroids inhibit the late response and prevent priming.

“Antihistamines,” explained Naclerio, “taken once symptoms have already appeared, arrive too late to block the early response and have little effect on the late response. Corticosteroids taken when symptoms begin can prevent the late response and inhibit priming, which makes the patient more sensitive to subsequent contacts.”

“Our study,” he added, “demonstrates the greater importance of the late response compared to the immediate response.”

The authors emphasize that continuous medication use is more effective than sporadic use in response to symptoms but acknowledge that few patients comply with those instructions.

In light of their findings, they suggest revising the current guidelines so that “intranasal corticosteroids should become the first-line treatment for seasonal allergies. They should now be recommended for regular use in patients with severe disease,” said Naclerio, “and for as-needed use in patients with mild disease.”

Robert Naclerio, M.D., chief of otolaryngology-head and neck surgery at the University of Chicago and director of the study, remarked more people will be benefiting and health costs can be dramatically reduced by altering the present guidelines to match patient practice.

According to a new study by researchers at Washington University School of Medicine and other institutions, asthmatic children who do not show much improvement with symptoms while using low-dose inhaled corticosteroids can expect benefit with doses of steroids are increased or one of two asthma drugs is added.

The study called BADGER (Best ADd-on therapy Giving Effective Responses) can help physicians in predicting which of their patients will be benefiting the most and from which of the available options.

From Sciencedaily.com:

To treat children whose asthma is not well controlled while using low-dose inhaled corticosteroids, the National Heart, Lung, and Blood Institute (NHLBI) guides physicians to try one of three additional, or step-up, treatments: doubling the dosage of the inhaled corticosteroid or adding a long-acting beta antagonist (LABA) or a leukotriene receptor antagonist (LTRA) to the inhaled corticosteroid treatment.

However, physicians often find it difficult to predict which step-up treatment might work best for a particular child. So the researchers in the five-center, NHLBI-funded Childhood Asthma Research and Education (CARE) Network used a novel triple-crossover, double-blind approach to determine if the treatments improved asthma symptoms, and if so, which treatment might work best.

Robert C. Strunk, M.D., and Leonard B. Bacharier, M.D., both Washington University pediatric asthma specialists at St. Louis Children’s Hospital, were coauthors on the study, published online March 2, 2010, by the New England Journal of Medicine and presented the same day at the American Academy of Allergy, Asthma and Immunology’s annual meeting in New Orleans.

Inhaled corticosteroids are becoming the obvious choice of more and more patients suffering from Chronic Obstructive Pulmonary Disease (COPD) but this practice didn’t find any support from a recently concluded study.

It was disclosed in the study that the risk of developing pneumonia is increased with the use of anti-inflammatory drugs and even leads to an increased number of hospitalization cases.

From Bio-Medicine.Org:

In their report, the researchers noted that the admission rate for pneumonia increased with higher doses of inhaled steroids and that reduction in risk was observed once the medications were stopped. Among all patients taking inhaled steroids, there was a 53 percent increase in pneumonia deaths within 30 days of being admitted to the hospital.

The investigators noted that these findings are particularly relevant, given that pneumonia is the third leading cause of hospitalization in the United States and that inhaled corticosteroid use among patients with COPD increased from 13.2 to 41.4 percent from 1987 to 1995.

Adverse effects of inhaled corticosteroids in patients with COPD, the authors said, are particularly troublesome given the limited evidence for their efficacy.

Hospitalization and drug prescription information from 1988-2003 of 175,906 patients with COPD and living in Quebec, Canada, were analyzed by Pierre Ernst, M.D., a clinical epidemiologist at McGill University, Canada, along with three other researchers from the university’s department of medicine.

Children whose asthma improved while taking steroid drugs for many years cannot expect the same benefits after stopping the use, as per new results from a comprehensive childhood asthma study.

The study, which was published in advance online publication of the Journal of Pediatrics, revealed that children using steroids during the trial and now in their late teens showed no differences in terms of asthma control when compared with the children who received the placebo.

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.

Robert C. Strunk, M.D., a Washington University pediatrician at St. Louis Children’s Hospital and lead author of the study, remarked that kids with asthma can experience better control as they grow older.

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.