Severe Asthma Research - October 2015
Christina E Ciaccio, MD, MSc
Assistant Professor of Pediatrics
University of Chicago Medicine
Comer Children’s Hospital
Chicago, Illinois, United States
Acute and chronic systemic corticosteroid-related complications in patients with severe asthma
Unfortunately, despite significant advances in the management of severe asthma, systemic corticosteroids (SCS) remain a mainstay of treatment. This longitudinal, open-cohort, observational study utilized Medicaid claims data from Florida, Iowa, Kansas, Missouri, Mississippi, and New Jersey and included over 3000 individuals. Individuals were included in the cohort if they had been on at least 6 months of SCS. Not surprisingly, those with medium and high SCS exposure had significantly higher risks of having any SCS-related complication, including cardiovascular complications, infections, and gastrointestinal complications compared with patients with low SCS exposure. In addition, patients with medium and high SCS exposure had more emergency department visits, more inpatient visits, and more pharmacy claims. These data support the observation that many individuals suffer the side effects of oral steroids while continuing to have inadequate asthma control. Continued efforts to identify steroid sparing treatments for severe asthma are needed.
Source: Lefebvre P, Duh MS, Lafeuille MH, Gozalo L, Desai U. Acute and chronic systemic corticosteroid – related complications in patients with severe asthma. Journal of Allergy and Clinical Immunology 2015; published online ahead of print, 20 September. (doi:http://dx.doi.org/10.1016/j.jaci.2015.07.046)
Ethnic variation in response to intramuscular triamcinolone in children with severe therapy resistant asthma.
Ethnic minorities have worse asthma outcomes, potentially indicating that these groups have a decreased response to treatment of asthmatic patients. In this study approximately 80 children were given intramuscular triamcinolone and monitored for response. Caucasian children experienced a significant drop in median FENO after receiving triamcinolone which was not seen in black children. In addition, Caucasian children were found to have a statistically significant drop in sputum eosinophils which was again not seen in black children. Finally, black children had significantly more asthma exacerbations following triamcinolone than Caucasian children. These data confirm that black children do not respond to triamcinolone in the same way that Caucasian children do. Although it is unclear, the mechanism of this observation is not from adherence.
Source: Koo S, Gupta A, Fainardi V, Bossley C, Bush A, Saglani S, Fleming L. Ethnic variation in response to intramuscular triamcinolone in children with severe therapy resistant asthma. Chest 2015; published online ahead of print, 17 September. (doi:10.1378/chest.14-3241)