Corticosteroids function tests

All patients were monosensitized with a persistence of symptoms despite action to eliminate mites and treatment with inhaled corticosteroids. Patients were included after an 8-week observation period which made it possible to determine the lowest effective dose of budesonide, with the performance of skin tests, lung function tests and a methacholine bronchial challenge test. The efficacy criteria were the medication and symptom scores, global assessment of the patient by the physician, skin tests and total IgE, lung function tests and the methacholine bronchial challenge test. 

A 46-year-old woman developed fatigue and jaundice about 20 weeks after she started to take nefazodone (300 mg/day). She had raised liver enzymes and bilirubin concentrations. There was no evidence of infectious hepatitis or immune disorders. Liver biopsy showed ballooning degeneration and necrosis of hepatocytes with mixed inflammatory infiltrates. The nefazodone was withdrawn and corticosteroid treatment started. Within 4 months she recovered clinically and her liver function tests returned to normal (11). 

HPI KG is a 39-year-old woman with asthma on fluticasone and albuterol complaining of SOB associated with exercise. Three months ago she started an aerobic exercise program that has been hampered by chest tightness and SOB shortly after she begins running. She admits to poor compliance with her corticosteroid inhaler and requests an oral medication to control her asthma symptoms. Her PMH is significant for mild, persistent asthma for 35 years and allergic rhinitis. Her medications include fluticasone and albuterol inhalers and fexofenadine. Pulmonary function tests (PFTs) reveal her forced expiratory volume in the first second (FEV,) = 89% of predicted. 

Ketoconazole has been associated with hepatic toxicity, hence necessitating liver function tests before, during, and after termination of the therapy. Ketoconazole reduces the serum level of testosterone, which returns to normal levels after discontinuation of therapy. It increases the plasma levels, bioavailability, or actions of oral anticoagulants, astemizole, terfenidine, corticosteroids, and cyclosporine, but decreases that of theophylline. 

Most patients with hepatic sarcoidosis do not require treatment (81). Although treatment with corticosteroids can improve liver function tests in approximately half of asymptomatic patients, three-fourths of such patients who are not treated eventually undergo spontaneous improvement in liver function tests and the rest remain stable (59). Furthermore, evidence suggests that corticosteroid treatment of hepatic sarcoidosis promotes relapse (87). On the basis of these data, therapy for hepatic sarcoidosis is not indicated in asymptomatic patients with Uver function test elevations. Such patients should be followed with serial Uver function tests, although it is rare for them to develop hepatic failure (59). 

Granulomatous hepatitis from sarcoidosis may require treatment if patients develop fever, nausea, vomiting, pruritus weight loss, or right upper-quadrant abdominal pain (67). Corticosteroids are usually effective in alleviating these symptoms (67,93). Many patients require a daily dose of prednisone in the 10 to 15 mg range. Therapy is often required for more than one year (67). Despite the potential risk of hepatic toxicity from methotrexate, it has been shown to be effective, reduce liver function test abnormalities, and to be corticosteroid sparing (67,95). 

Airway hyperresponsiveness is defined as the exaggerated ability of the airways to narrow in response to a variety of stimuli. Although AHR exists in patients without asthma, it is a characteristic feature of asthma and appears to be directly related to airway inflammation and the severity of asthma.1,3 Treatment of airway inflammation with inhaled corticosteroids attenuates AHR in asthma but does not eliminate it.1 Clinically, AHR manifests as increased variability of airway function. Although not commonly used to diagnose asthma, AHR can be evaluated clinically using a methacholine or histamine bronchoprovocation test. 

Tetracosactide (tetracosactrin) is an analogue of corticotrophin (ACTH) and is used to test adrenocortical function. It is administered by intramuscular injection. Side-effects are very similar to those with corticosteroids. 

Corticotropin (corticotrophin adrenocorticotrophin ACTH) is a straight-chain polypeptide with39 amino acid residues, and its function is to control the activity of the adrenal cortex, particularly the production of corticosteroids. Secretion of the hormone is controlled by corticotropin-releasing hormone (CRH) from the hypothalamus. ACTH was formerly used as an alternative to corticosteroid therapy in rheumatoid arthritis, but its value was limited by variable therapeutic response. ACTH may be used to test adrenocortical function. It has mainly been replaced for this purpose by the synthetic analoguetetracosactide (tetracosactrin) (Figure 7.10), which contains the first 24 amino acid residues of ACTH, and is preferred because of its shorter duration of action and lower allergenicity. 

In an own study we tested topical corticosteroids in combination with 5% lanolic acid.68 An improvement of barrier function could be detected. Formulations containing co-3 and co-6 fatty acids may help in the restoration of barrier properties. Higher efficacy of these products may be achieved by combining different classes of stratum corneum lipids 68 Escobar et al.64 showed a clinical improvement of scaling and plaque thickness for topical fish oil compared to the base-treated site in a four week treatment64... 

Corticosteroids — Beclomethasone dipropionate (17) aerosol has been tested extensively clinically. It is used prophylactically (400 fig per day), not therapeutically, in the treatment of chronic asthma, particularly in children.52 An evaluation of the drug has been published.53 One of the most important clinical advantages is that 1 7 effectively can replace oral corticosteroids in steroid-dependent patients and avoid many of the adverse effects of adrenal suppression.52,54 Most patients with impaired adrenal function due to oral corticosteroids show recovery of adrenal function within 6 months.55 The combination of 17 and disodium cromoglycate (DSCG) showed no additive therapeutic effects.5 Flunisolide (18), when administered as a nasal spray for 4 weeks during the hay fever season in 51 patients, showed significant symptomatic improvement with no systemic steroid effects observed.57... 

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