Steroid resistance in asthma: our current understanding.
While much information has recently been obtained regarding the features of steroid-resistant asthma, it continues to be a dilemma for practitioners, and investigation into its mechanisms will remain an important part of asthma research. Until a clear marker defining steroid-resistant asthmatics is found, the principle first put forth by Carmichael and colleagues should be adhered to: that is, asthmatics resistant to glucocorticoid therapy need to be identified at an early stage so that unnecessary and perhaps harmful therapy can be discontinued. A 10 day course of high-dose (> or = 30 mg/day) systemic glucocorticoid therapy, as suggested by Kamada and colleagues, may constitute an adequate trial and may sufficiently identify asthmatics who may require alternative treatments. A more rational approach to the selection of alternative asthma treatments will be gained when the mechanisms of steroid resistance are identified.
Kamada
A K
AK
Ira J. and Jacqueline Neimark Laboratory for Clinical Pharmacology in Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.
Leung
D Y
DY
Szefler
S J
SJ
D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D003907:Dexamethasone / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011241:Prednisone / Q000494:pharmacology; D013601:T-Lymphocytes / Q000187:drug effects
D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone