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[Corticosteroid-resistant asthma: basic aspects].

D Jaffuel1, M Mathieu, P Chanez

  • 1INSERM U454, Hôpital Arnaud de Villeneuve, Montpellier.

Presse Medicale (Paris, France : 1983)
|May 6, 1999
PubMed
Summary
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The definition of corticosteroid-resistant asthma lacks consensus, impacting treatment. Current definitions overlook clinical benefits, necessitating individualized patient care for better asthma management.

Area of Science:

  • Pulmonology
  • Pharmacology

Context:

  • The current definition of corticosteroid-resistant asthma relies on spirometry but lacks standardized criteria for diagnosis.
  • Significant patient populations, nearly half, are on long-term oral steroids, yet clinical benefits are often excluded from resistance definitions.
  • This ambiguity complicates the identification and management of patients with true corticosteroid resistance.

Purpose:

  • To highlight the limitations and controversies surrounding the current definition of corticosteroid-resistant asthma.
  • To discuss the complex pathogenesis involving pharmacokinetic and cellular anomalies.
  • To outline prerequisites for alternative therapies and emphasize the need for clinically evident resistance.

Summary:

  • The definition of corticosteroid-resistant asthma is debated, lacking consensus on diagnostic parameters like dose, duration, route, and FEV1 reversibility.

Related Experiment Videos

  • Pathogenesis involves complex anomalies in glucocorticoid pharmacokinetics, cytokine regulation, cell function, and transcription factors.
  • Therapeutic management is challenging, requiring confirmed asthma diagnosis, environmental control, compliance, and documented lack of clinical benefit from corticosteroids before considering alternative treatments.
  • Impact:

    • Clarifying the definition of corticosteroid resistance is crucial for accurate diagnosis and appropriate treatment selection.
    • Understanding the complex pathogenesis may lead to targeted therapies.
    • Establishing clear criteria for alternative treatments ensures patient safety and optimizes outcomes in difficult-to-treat asthma.