Clinical outcomes of steroid-insensitive asthma.
BACKGROUND
Steroid insensitivity increasingly is being recognized in patients with severe, chronic asthma. Virtually no data exist regarding the clinical outcomes of steroid insensitive (SI) asthma despite clear expectations of poorer longitudinal course for this condition.


METHODS
We obtained 2-year follow-up data from 34 pediatric patients who had been evaluated for steroid insensitivity at a national asthma referral center. Outcomes evaluated included current oral glucocorticoid (GC) dose; number of GC bursts, emergency room visits, and hospitalizations for asthma in the prior 12 months; Asthma Functional Severity; Pediatric Asthma Quality of Life; and Pediatric Asthma Caregiver's Quality of Life.


RESULTS
At follow-up, patients with SI asthma and their caregiving parent both reported poorer quality of life (QOL) compared with those with steroid sensitive (SS) asthma (adolescent: 4.6 +/- 0.4 versus 5.6 +/- 0.3; P < .05; caregiver: 5.1 +/- 0.4 versus 6.2 +/- 0.2; P < .05). Steroid-insensitive patients showed no significant difference in GC dose, number of GC bursts, emergency room visits or hospitalizations, or Asthma Functional Severity compared with SS patients.


CONCLUSIONS
Steroid insensitivity was associated with significantly poorer QOL at 2-year follow-up. Steroid insensitive patients did not show poorer clinical outcomes compared with SS patients as assessed by current steroid requirements and health care utilization. Overall, the observed pattern of results suggests that SI asthma may be a worse form of asthma because a more fixed pattern of lung obstruction has developed. Further longitudinal study of the clinical and cellular outcomes of SI asthma is needed to more fully characterize the types and magnitude of risks associated with SI status.
Wamboldt
F S
FS
Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado 80206, USA. wamboldtf@hjc.org
Spahn
J D
JD
Klinnert
M D
MD
Wamboldt
M Z
MZ
Gavin
L A
LA
Szefler
S J
SJ
Leung
D Y
DY
D000293:Adolescent; D001249:Asthma / Q000517:prevention & control*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D005938:Glucocorticoids; D013256:Steroids; D011241:Prednisone