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Cutaneous vasoconstrictor response to glucocorticoids in asthma
P H Brown1, S Teelucksingh, S P Matusiewicz
1Department of Medicine, Northern and Western General Hospitals, Edinburgh, UK.
Lancet (London, England)
|March 9, 1991
Summary
Asthma patients resistant to corticosteroid treatment show reduced skin vasoconstrictor response to topical glucocorticoids. This suggests a general tissue defect in glucocorticoid response in corticosteroid-resistant (CR) asthma.
Area of Science:
- Pulmonology
- Dermatology
- Pharmacology
Background:
- Asthma patients exhibit varying responses to corticosteroid therapy, categorized as corticosteroid-sensitive (CS) or corticosteroid-resistant (CR).
- The underlying mechanisms of corticosteroid resistance in asthma are not fully understood.
- Investigating peripheral tissue responses may offer insights into systemic glucocorticoid resistance.
Purpose of the Study:
- To determine if corticosteroid-sensitive (CS) and corticosteroid-resistant (CR) asthma patients differ in their skin's vasoconstrictor response to topical glucocorticoids.
- To explore potential systemic implications of corticosteroid resistance in asthma.
Main Methods:
- A topical glucocorticoid (beclomethasone dipropionate) was applied to forearm skin at various concentrations in CS asthma patients, CR asthma patients, and healthy volunteers.
- Skin blanching, an indicator of vasoconstriction, was assessed after 18 hours of occlusion.
- Corticosteroid resistance was defined by a lack of significant improvement in lung function (FEV1, PEFR) after oral corticosteroid treatment.
Main Results:
- CS asthma patients, mild asthma patients, long-term prednisolone users, and healthy volunteers exhibited similar vasoconstrictor responses to topical glucocorticoids.
- CR asthma patients demonstrated a significantly lower vasoconstrictor response compared to CS asthma patients at lower concentrations (3, 10, and 30 µg/ml) of beclomethasone dipropionate.
- No significant difference in response was observed at the highest concentration (100 µg/ml).
Conclusions:
- Corticosteroid-resistant asthma is associated with reduced cutaneous vasoconstrictor response to topical glucocorticoids.
- This finding, along with evidence of glucocorticoid resistance in leukocytes, suggests a potential generalized defect in glucocorticoid responsiveness in CR asthma patients.
- Further research is warranted to elucidate the mechanisms of systemic glucocorticoid resistance in asthma.
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