Steroids asthma management

Aerosolized steroids clearly play an important role in the present-day management of asthma (87). They are reasonably safe and work best when taken prophylacticaHy. Patient compliance, however, remains a significant problem. In part this problem is typical of any aerosolized agent. But in the case of steroids, the problem is exacerbated because a patient needs to take the steroids (especially prednisone) are the antiasthmatic agents of last resort and are widely used to treat status asthmaticus. An agent that could mimic the actions of steroids but which would work faster and/or without side effects might be the ideal antiasthmatic agent. 

Glucocorticoids (GCs) are the mainstay of anti -inflammatory therapy, but some 25% of asthmatic patients are resistant to GC therapy, presenting a serious problem in the management of chronic asthma [74-77]. A series of investigations based on knowledge of the mechanism of steroid action, reviewed below, implicates SEs in steroid resistance. 

Budesonide is a corticosteroid/flucocorticoid/intranasal steroid. It exhibits a wide range of inhibitory activities against multiple cell types and mediators involved in aller-gic-mediated inflammation. Its indications are Intranasal management of seasonal and perennial allergic rhinitis symptoms in adults and children oral inhalation for the maintenance treatment of asthma as prophylactic therapy in adults and children and for patients requiring oral corticosteroid therapy for asthma inhalation suspension maintenance treatment of asthma and prophylactic therapy in children 12 months to 8 years of age oral capsule Crohn s disease. 

Recent studies using the T-cell-selective agent cyclosporin A (CsA) have shown promising results in the management of steroid-dependent asthma. Trials of CsA treatment in steroid-dependent asthma have resulted in improved lung function, a reduction in asthma exacerbations, and a reduction of IL-2 and IL-2 receptor expression and the transcription and translation of mRNA for IL-5 and GM-CSF in CD4+ T cells (349). 

Leung DY, Spahn JD, Szefier SJ. Immunologic basis and management of steroid-resistant asthma. Allergy Asthma Proc 1999 20 9-14. 

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