PURPOSE: Adherence to treatment with inhaled corticosteroids (ICS) is a critical determinant of asthma control. The objective of this study was to assess factors that determine adherence to ICS therapy in children with asthma. METHODS: Fifty-eight children with asthma, aged 5 to 16 years, used ICS with or without a spacer for 3 months. Adherence rates as measured from questionnaires and canisters, asthma symptom scores, and inhalation technique scores were assessed every 30 days. The degree of supervision by caregivers was assessed at day 30. RESULTS: Adherence rates measured using canisters were lower at day 60 than at day 30 (P=0.044) and did not change thereafter (74.4%+/-17.4% at day 30, 66.5%+/-18.4% at day 60, and 67.4%+/-22.2% at day 90). Adherence rates at days 60 and 90 and during the total study period were significantly different when measured by using questionnaires versus canisters (P<0.001, P=0.022, and P=0.001, respectively). In the comparison of adherence rates repeatedly measured at days 30, 60, and 90 and adherence rates during the total study period among the 3 groups, adherence rates in the high-degree supervision group were significantly higher than those in the low-degree supervision group (82.0+/-16.0 vs. 66.1+/-14.5, 75.4+/-14.4 vs. 56.2+/-18.4, 75.0+/-18.3 vs. 55.0+/-19.7 [P=0.027]; 77.9+/-12.2 vs. 59.1+/-11.4 [P=0.021]) after adjustment for sex and age. CONCLUSION: The level of caregiver supervision is an important factor affecting adherence to ICS therapy in children with asthma. Therefore, a high degree of supervision may be required to increase adherence to ICS therapy in children with asthma.
Adrenal Cortex Hormones* ; Asthma* ; Caregivers ; Child* ; Humans ; Inhalation ; Organization and Administration*

BACKGROUND AND OBJECTIVES: Corticosteroids have been used for therapeutic management of sudden sensorineural hearing loss (SSNHL). Because of the complications associated with systemic steroid therapy and low levels of steroid in the inner ear after systemic administration, intratympanic steroid injection (ITSI) is currently used. The purpose of this study was to compare the efficacy of systemic steroid therapy with systemic combined high frequency ITSI therapy. SUBJECTS AND METHODS: Forty-six SSNHL patients were divided into the only systemic dexamethasone therapy group (systemic steroid IV group, 27 patients) and the systemic with frequent intratympanic dexamethasone injection group (combined ITSI group, 19 patients). In the systemic steroid IV group, dexamethasone was administered intravenously for 5 days followed by oral tapered doses for 10 days. In the combined ITSI group, intratympanic dexamethasone was administered 5 times per day for 5 consecutive days in addition to intravenous administration of dexamethasone. Hearing was assessed both before therapy and at 15 days, 4 weeks, and 8 weeks after the initiation of therapy. RESULTS: The recovery rate and hearing gain were 74% (20 out of 27 patients) and 33 dB mean improvement in the systemic steroid IV group and 73.6% (14 out of 19 patients) and 41.5 dB mean improvement in the combined ITSI group. There was no statistically significant difference in hearing gain and the recovery rate between the two groups. CONCLUSIONS: The therapeutic effect of a combination of highly frequently administered intratympanic dexamethasone and systemic steroid therapy was not superior to only systemic steroid injection therapy.
Administration, Intravenous ; Adrenal Cortex Hormones ; Dexamethasone ; Ear, Inner ; Hearing ; Hearing Loss, Sensorineural ; Humans

Bronchial thermoplasty is a nonpharmacological treatment for severe asthma that delivers thermal energy to the bronchial walls and reduces hypertrophied smooth muscle mass. Previous studies have shown its efficacy and safety, resulting in approval from the Food and Drug Administration in 2010. In Korea, the first bronchial thermoplasty was carried out in 2014; 4 patients have undergone the procedure so far. This case series presents the medical history and treatment outcomes of these 4 patients. All patients presented with uncontrolled asthma despite optimal medical treatment. Bronchial thermoplasty was performed at the right lower lobe, left lower lobe, and both upper lobes in order at 3-week intervals. All procedures were performed under general anesthesia. Two patients had significant decreases in exacerbations and required a lower dose of inhaled corticosteroids after the procedure. One patient had slightly fewer exacerbations but failed to reduce the use of systemic corticosteroids. One patient had no change in symptoms. One limitation of bronchial thermoplasty is the difficulty of predicting clinical responders. However, since more therapeutic options are needed in the management of severe asthma, especially T2-low asthma, discussion with experts about the feasibility and necessity of bronchial thermoplasty will ensure the best possible care.
Adrenal Cortex Hormones ; Anesthesia, General ; Asthma ; Humans ; Korea ; Muscle, Smooth ; United States Food and Drug Administration

Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Arthritis, Juvenile ; drug therapy ; Humans ; Injections, Intra-Articular

Most patients with asthma have mild to moderate disease and are well controlled by regular use of inhaled corticosteroids with or without long-acting beta2-agonists. However, about 5-10% patients with severe asthma remain poorly controlled despite optimal treatment, and these patients have greater morbidity and mortality than mild to moderate asthmatics. Patients with severe refractory asthma (SRA) often require regular systemic corticosteroid use, which increase risk of steroid-related adverse events and require more health care support. A systematic approach is necessary to establish a correct diagnosis, identify coexisting disorders, and evaluate aggravating factors. The management of SRA remains extremely challenging, and many clinical studies are currently in progress. Anti-IgE antibody (omalizumab) and bronchial thermoplasty may be alternative treatment for SRA approved by US Food and Drug Administration. SRA is a heterogeneous disease, which is classified in to distinct clinical phenotypes. A better understanding of these subtypes may lead to improved treatment of SRA.
Adrenal Cortex Hormones ; Antibodies, Anti-Idiotypic ; Asthma ; Delivery of Health Care ; Humans ; Phenotype ; United States Food and Drug Administration

BACKGROUND: It is well known that topical and systemic corticosteroids can arrest the progress of vitiligo and lead to repigmentation. However, it may also produce unacceptable side effects. To minimize the side effects of systemic corticosteroids, there have been some reports of using high-dose methylprednisolone pulse therapy in vitiligo. But, there has been no report on the effectiveness of the combined treatment with phototherapy. OBJECTIVE: We evaluated the efficacy, safety, and tolerability of combination therapy of intravenous methylprednisolone pulse therapy and PUVA. METHODS: A study was performed on 31 patients with vitiligo who could undergo follow up study for at least 6 months. After intravenous administration of methylprednisolone 25 mg/kg/day for 3 consecutive days, PUVA phototherapy was given once or twice a week for the next 6 months. RESULTS: After 6 months, vitiligo lesions on the face showed 60.7% improvement, and the upper extremities showed 34.5% improvement. The trunk and lower extremities showed 25.1% and 25.8% improvement respectively. Compared with other sites, lesions on the feet (13.2%) and periungal area (0%) showed poor improvement. The overall improvement in 12 patients (38.7%) showed more than 50% repigmentation. Side effects occurred in a small number of patients and were transient. CONCLUSION: Combination treatment of high-dose methylprednisolone pulse therapy and PUVA may provide a therapeutic option for generalized vitiligo, with high effectiveness and low side effects.
Administration, Intravenous ; Adrenal Cortex Hormones ; Follow-Up Studies ; Foot ; Humans ; Lower Extremity ; Methylprednisolone* ; Phototherapy ; Upper Extremity ; Vitiligo*

OBJECTIVE: To explore the intervention measures to maintain clinical control in children with asthma in the remission stage when concomitant with acute upper respiratory infection (AURI). METHODS: A total of 100 asthmatic children who had achieved clinical control were randomly divided into observation group and control group. The two groups were both treated with a combination of inhaled corticosteroids and long-acting β2 receptor agonist (ICS/LABA) at the lowest dose every night. Conventional therapies were used for the two groups when suffering from AURI. In addition to conventional therapies, the observation group was given early short-term upgrade therapy, i.e., on the basis of maintenance therapy, the same amount of ICS/LABA complex preparation was inhaled every morning, which lasted for 7-10 days. Both groups were treated following asthma guidelines according to the severity of the disease at the time of acute attacks. The control rate of asthma, severity of acute attacks, changes in pulmonary function indices, and occurrence of adverse events were evaluated after 3, 6, 9, and 12 months of treatment. RESULTS: At each time point of follow-up, the rate of asthma control in the observation group was significantly higher than that in the control group (90% vs 80%; P<0.05). The severity of acute attacks in the observation group was significantly lower than that in the control group at all follow-up time points (P<0.05). Compared with the control group, the observation group had significantly improved pulmonary function indices of large and small airways (P<0.05) and significantly reduced mean amount of inhaled glucocorticoids and impact on family life (P<0.01). CONCLUSIONS Early short-term upgrade therapy for children with asthma in the remission stage when concomitant with AURI can prevent acute attacks of asthma, raise the rate of asthma control and improve pulmonary function.
Administration, Inhalation ; Adrenal Cortex Hormones ; Adrenergic beta-Agonists ; Anti-Asthmatic Agents ; Asthma ; Child ; Drug Therapy, Combination ; Humans

OBJECTIVE: To study the incidence of acute attacks of asthma and dynamic changes in laboratory markers in children with well-controlled asthma after the withdrawal of low-dose inhaled corticosteroids (ICS), and to provide a basis for optimal long-term control regimens for children with asthma. METHODS: A total of 63 children with well-controlled asthma were enrolled as subjects. According to their parents' wishes, they were continuously administered with ICS (ICS treatment group; n=35) and without ICS (ICS withdrawal group; n=28). They were followed up for 18 months. The incidence of acute attacks of asthma was evaluated, dynamic monitoring was performed for pulmonary function and fractional exhaled nitric oxide (FeNO), and childhood asthma control test (C-ACT) was performed every three months. RESULTS: At 3, 6, 9, and 12 months of follow-up, there was no significant difference in FeNO between the ICS treatment and withdrawal groups (P>0.05). However, at 15 and 18 months of follow-up, the withdrawal group had a significantly higher level of FeNO than the ICS treatment group (P<0.05). There was no significant difference in the C-ACT score between the two groups at all time points of follow-up (P>0.05). At 3, 6, 9, and 12 months of follow-up, there were no significant differences between the two groups in the percentage of forced expiratory volume in 1 second, the ratio of forced expiratory volume in 1 second to forced vital capacity, percentage of predicted maximum mid-expiratory flow (MMEF%), and maximal expiratory flow at 50% of vital capacity (MEF50) (P>0.05), while at 15 and 18 months of follow-up, the ICS treatment group had significantly higher MMEF% and MEF50 than the withdrawal group (P<0.05). During follow-up, 3 children (9%) in the ICS treatment group and 8 (29%) in the withdrawal group experienced acute attacks of asthma (P=0.0495). CONCLUSIONS Continuous inhalation of low-dose ICS can maintain the stability of pulmonary function and reduce acute attacks of asthma in children with well-controlled asthma.
Administration, Inhalation ; Adrenal Cortex Hormones ; Anti-Asthmatic Agents ; Asthma ; Child ; Follow-Up Studies ; Forced Expiratory Volume ; Humans ; Nitric Oxide

Early stage mycosis fungoides (MF) is known to be responsive to various topical and systemic therapies such as corticosteroids and ultraviolet light radiation, photochemotherapy with psoralens and whole-body electron beam irradiation. However, these treatments have all revealed a high relapse rate. Thus, we suggest that more invasive therapy, including PUVA combined with interferon-gamma, is one of the possible treatments for early MF because this treatment displays a reduced relapse rate. We report here on a case of early stage MF (Stage Ib) that was successfully treated with PUVA (total dose: 105.7 J/cm2) and intravenous administration of recombinant human interferon-gamma (total 5.4x10(6) IU), and the patient has been without relapse 1 year after treatment.
Administration, Intravenous ; Adrenal Cortex Hormones ; Electrons ; Ficusin ; Humans ; Interferon-gamma ; Mycosis Fungoides ; Photochemotherapy ; Psoralens ; Recurrence ; Ultraviolet Rays

Two cases of toxic epidermal necrolysis (Lyell) appearing on 69-year old male and 12year-old female were presented. The clinical manifestations of toxic epidermal necrolysis developed after oral administration of novaquing for common cold. The cause of the disease was probably due to novaquing (phenobarbital and sulpyrin). The 69 year-old male was expired despite intensive treatment with fluid and electrolytes, antibiotics, corticosteroids, vitamins, and topical measures, but 12 year-old female was cured successfully with treatment.
Administration, Oral ; Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Child ; Common Cold ; Electrolytes ; Female ; Humans ; Male ; Stevens-Johnson Syndrome* ; Vitamins