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Oral corticosteroid-dependent asthma: a 30-year review
Inderpal Randhawa1, William B Klaustermeyer
1UCLA West Los Angeles VA, Los Angeles, California 90073, USA. docrandhawa@yahoo.com
Summary
Corticosteroid-dependent asthma management lacks consensus. Systemic glucocorticoids are primary, but novel therapies like omalizumab show promise for reducing steroid needs, though careful monitoring for side effects is crucial.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Corticosteroid-dependent asthma presents unique challenges in management.
- Identifying effective corticosteroid-sparing strategies is crucial for patient well-being.
Purpose of the Study:
- To review current knowledge on the pathogenesis of corticosteroid-dependent asthma.
- To evaluate existing and emerging therapeutic options and prophylaxis measures.
- To identify novel aspects of managing this condition.
Main Methods:
- Comprehensive literature search of PubMed (1966-2006) and conference abstracts.
- Inclusion criteria based on reviewer agreement after assessing study methods and discussion.
- Quality assessment performed by two independent reviewers.
Main Results:
- High-dose inhaled corticosteroids are the primary treatment.
- Omalizumab is effective for allergic asthma, reducing oral steroid use.
- Other agents (methotrexate, gold, cyclosporine) show sparing effects but carry risks; nebulized diuretics and lidocaine are promising but need more research. Clarithromycin, telithromycin, and etanercept have preliminary or uncertain roles.
Conclusions:
- No definitive consensus exists for corticosteroid-sparing treatments.
- Systemic glucocorticoids remain the cornerstone therapy.
- Monitoring and prophylaxis for adverse effects of systemic glucocorticoids are essential.
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