Corticosteroids clinical effects

Inhaled corticosteroids are not equivalent on a milligram basis however, equivalent doses have been approximated (Table 11-3). Low to moderate doses have been shown to be safe and effective in all age groups. Although some effect is seen from inhaled corticosteroids within 12 hours, 2 weeks of therapy is necessary to see significant clinical effects, and longer treatment periods maybe necessary to see the full effect of these agents on airway inflammation and remodeling. 

Guslandi M, Giollo P, Testoni PA Corticosteroid-sparing effect of rifaximin, a nonabsorbable oral antibiotic in active ulcerative colitis Preliminary clinical experience. Curr Ther Res 2004 65 292-296. 

Topical corticosteroids are available in ointments, creams, lotions, gels, sprays, shampoos, and mousses. An ointment is considered the most clinically effective dosage form in psoriasis treatment because it consists of an oily phase that is occlusive and conveys a hydrating effect. Due to the lipophilicity of ointments, penetration of corticosteroid into dermis is enhanced, resulting in increased vasoconstriction. 

Information about the clarithromycin or erythromycin interactions with methylprednisolone is much more limited than with the interaction between troleandomycin and methylprednisolone, but they all appear to be established and of clinical importance. The effect should be taken into account during concurrent use and appropriate dosage reductions made to avoid the development of corticosteroid adverse effects. The authors of one study suggest that this reduction should be empirical, based primarily on clinical symptomatology. Another group found that a 68% reduction in methylprednisolone dosage was possible within 2 weeks. Troleandomycin appears to have a greater effect than erythromycin or clarithromycin. 

The reformulation of beclomethasone MDI formulations using HFA propellants has provided us with some insight as to the relationship between the particle size and the aerosol velocity of corticosteroids delivered by MDI and their clinical effect. Particles generated from an HFA-MDI containing the newly formulated beclomethasone aerosol primarily are composed of 1.1- to 2.1-pm particles, compared to 3.3- to 4.7-pm particles generated by the older CFC-MDI (59). At the same time. 

Deakin(70 ) points out that topical corticosteroids have 3 main actions in the skin (1) they suppress inflammation and allergic reactions, (2) they produce prolonged vasoconstriction, and (3) they have an antimitotic effect. The vasoconstriction more or less parallels their clinical effectiveness. 

Corticosteroids may of course furthermore be procarcinogenic by virtue of their suppression of the immunological defense mechanism. Deakins (70 ) points out that the face is the most common site of corticosteroid side effects. Two clinical entities may be produced a rosacea-like syndrome and perioral dermatitis. 

Spiteri MA, Poulter LW, Clarke SW. Inhaled versus systemic corticosteroids in pulmonary sarcoidosis a comparison of their immunological and clinical effects. Thorax 1991 46 322. 

The most common adverse effects from inhaled corticosteroids include oropharyngeal candidiasis and hoarse voice. These can be minimized by rinsing the mouth after use and by using a spacer device with metered-dose inhalers. Increased bruising and decreased bone density have also been reported the clinical importance of these effects remains uncertain.1,2,19... 

Pain and joint function have been evaluated frequently in clinical trials administering hyaluronan to patients with OA. Results are conflicting, with some suggesting dramatic improvements and others indicating no effect. In one controlled trial, hyaluronan injections relieved pain to a similar extent as oral NSAIDs.29 Hyaluronan provides greater pain relief for a longer time than intraarticular corticosteroids, but corticosteroids work more rapidly.29... 

Intranasal anticholinergic agents (e.g., ipratropium) reduce the severity and duration of rhinorrhea but have no effect on other nasal symptoms.11,12,21 Ipratropium reduces cholinergic hyperreactivity and cholinergically mediated histamine- and antigen-induced secretion. Intranasal ipratropium acts locally, with only minimal systemic absorption. Clinical trials demonstrated that ipratropium bromide 0.3% reduced rhinorrhea in adults and children with PAR.11,12 Intranasal ipratropium is an option for patients in whom rhinorrhea is refractory to topical intranasal corticosteroids and/or antihistamines.8,12 Intranasal ipratropium is available only by prescription, and the dose is two sprays nasally two to three times daily.15 Adverse effects are minimal, but dry nasal membranes have been reported.11,12... 

Results from clinical trials suggest that patients with acute COPD exacerbations should receive a short course of IV or oral corticosteroids. Although the optimal dose and duration of treatment are unknown, it appears that a regimen of prednisone 40 mg orally daily (or equivalent) for 10 to 14 days can be effective for most patients. 

---