title: Strategies for improving the efficacy and therapeutic ratio of glucocorticoids.
abstract: Although glucocorticoids are very effective in suppressing inflammation there is a clear clinical unmet need for new or improved glucocorticoids in patients with severe asthma and COPD. Recent developments include the targeted deposition of ultrafine glucocorticoid particles to treat small airways and the potential of novel agents that have a reduced side effect profile. Understanding the drivers of relative glucocorticoid resistance in these patients may lead to the development of newer drugs aimed at subsets of patients, for example asthmatics with high periostin levels. Alternatively, inhibitors of kinase pathways that are associated with inflammatory responses may be able to modulate glucocorticoid function and combinations of these inhibitors along with novel glucocorticoids may provide the combination therapy of the future.
authors.affiliation: Airways Disease, National Heart & Lung Institute, Imperial College London, SW3 6LY, UK. ian.adcock@imperial.ac.uk
authors.forename: Ian M
authors.initials: IM
authors.lastname: Adcock
authors.forename: Gaetano
authors.initials: G
authors.lastname: Caramori
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kirkham
mesh_terms: D000818:Animals; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D004359:Drug Therapy, Combination; D015507:Drugs, Investigational / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007107:Immune System / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D008168:Lung / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D058990:Molecular Targeted Therapy; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000276:immunology* / Q000378:metabolism
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D015507:Drugs, Investigational; D005938:Glucocorticoids; D047428:Protein Kinase Inhibitors