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Bronchodilators are critical in managing asthma, a chronic respiratory condition characterized by airway constriction due to inflammation and hyper-reactivity. Specifically, bronchodilators ease this constriction by relaxing the bronchial muscles, facilitating easier breathing.
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Asthma presents with a characteristic pattern of episodic respiratory symptoms that reflect underlying airway inflammation, bronchoconstriction, and mucus hypersecretion. Although severity varies among individuals, certain clinical manifestations are considered hallmarks of the disorder and often guide diagnosis and assessment.Respiratory SymptomsA persistent cough is one of the most common early features of asthma. It is frequently dry and tends to worsen at night or in the early morning,...
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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Prednisolone disposition in steroid-dependent asthmatics

J Q Rose, J A Nickelsen, E Middleton

    The Journal of Allergy and Clinical Immunology
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    Steroid-dependent asthmatics do not clear prednisolone faster than healthy individuals. Their high prednisone needs are likely due to steroid-receptor sensitivity or disease severity, not drug metabolism.

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    Area of Science:

    • Pharmacology
    • Pulmonology
    • Clinical Medicine

    Background:

    • Severe asthma often requires high corticosteroid doses.
    • The reason for high prednisone requirements in some steroid-dependent asthmatics is unclear.
    • Potential factors include disease process, cellular response, or drug pharmacokinetics.

    Purpose of the Study:

    • To investigate if rapid prednisolone clearance contributes to high prednisone requirements in severe steroid-dependent asthmatics.
    • To compare prednisolone pharmacokinetics and eosinopenic response between asthmatics and healthy volunteers.

    Main Methods:

    • Administered intravenous prednisolone phosphate (40 mg) to 7 severe steroid-dependent asthmatics and 13 healthy volunteers.
    • Measured plasma concentrations of prednisolone, prednisone, and cortisol via high-performance liquid chromatography over 8 hours.
    • Monitored circulating eosinophil counts concurrently.

    Main Results:

    • Apparent half-life, plasma clearance, and volume of distribution of prednisolone were similar in both asthmatic and normal groups.
    • No differences in unbound prednisolone clearance were observed.
    • The eosinopenic response to prednisolone was comparable between groups.

    Conclusions:

    • Prednisolone binding, distribution, and clearance are not responsible for high prednisone requirements in steroid-dependent asthmatics.
    • Greater steroid-receptor sensitivity or disease severity/pathophysiology are more probable causes for increased prednisone dosage needs.