Cystic fibrosis corticosteroids

Conway, S. and Watson, A. 1997. Nebulized bronchodilators, corticosteroids and rhDNase in adult patients with cystic fibrosis. Thorax 52(2), S64-S68. 

Ronghe, M. et al. (2001). Remission induction therapy for childhood acute lymphoblastic leukaemia clinical and cellular pharmacology of vincristine, corticosteroids, L-asparaginase and anthracyclines. Cancer Treat. Rev. 27(6), 327-337. Welsh, M. Smith, A. (1995). Cystic fibrosis. Sci. Am. (December), 36-43. 

Saprophytic colonization is found with increased incidence in patients with underlying pulmonary diseases, such as in advanced stages of chronic obstructive pulmonary disease, chronic asthma requiring administration of adrenal corticosteroids, primary ciliary dyskinesia syndrome and cystic fibrosis [4-7]. A.fumigatus is the predominant species cultured from the respiratory tract although other Aspergillus species may also be found occasionally. 

ABPA is regarded as a complication of asthma, and occurs in approximately 1% of asthmatic patients. In addition to fever and malaise, the acute phase presents as an acute, easily reversible asthmatic syndrome with dyspnea and transient pulmonary infiltrations of eosinophils, neutrophils and lymphocytes, which may be effectively treated with corticosteroids. This condition usually progresses to a corticosteroid dependent and more intractable asthmatic state with transient pulmonary infiltrates (pulmonary eosinophilia) and a high sensitization to Aspergillus. From there the usual progression of the disease is to fibrosis and bronchiectasis. Most patients come to medical attention before the age of 35 years. The disease is a common complication of cystic fibrosis. 

Duma.se alpha is indicated for the treatment of cystic fibrosis in conjunction with other available therapies, such as antibiotics, brunchodilators, and corticosteroids. Adult dosage is 2.S mg inhaled once daily, administered via a recommended nebulizer. Dornase alpha. should not be mixed or diluted with other agents in the nebulizer becau.se of the possibility of adverse physicochemical changes that may affect activity. Common adverse effects include sure throat. hoarsene.s.s. and facial edema. 

Two other reports describe the development of Cushing s syndrome in patients with cystic fibrosis given inhaled budesonide, and then itraconazole for bronchopulmonary aspergillosis. One patient was also taking clarithromycin, which may have contributed to the increased budesonide effects (see also Corticosteroids+Macrolides , p. 1056). The other patient was a 4-year-old boy who developed Cushing s syndrome 2 weeks after starting treatment with itraconazole 200 mg daily and inhaled budesonide 400 micrograms daily. ... 

Some macrohdes have been found to have anti-inflammatory properties and are being used in airway diseases such as panbronchioUtis, cystic fibrosis, bronchiectasis, and asthma. The treatment of OP with erythromycin or clarithromycin has been reported in small series (121—124). After three months of therapy, full or partial remission was achieved in most patients, whereas others required addition of prednisone for disease control. Although their effect appears slower and less constant than with corticosteroids, macrolides might become a therapeutic option in OP, either alone or associated with corticosteroids. This issue requires further studies. 

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