A major burden of severe asthma is the future risk of adverse health outcomes. Patients with severe asthma are prone to serious exacerbation and deterioration of lung function and may experience side effects of medications such as oral corticosteroids (OCSs). However, such future risk is not easily measurable in daily clinical practice. In particular, currently available tools to measure asthma control and asthma-related quality of life incompletely predict the future risk of medication-related morbidity. This is a significant issue in asthma management. This review summarizes the current evidence of future risk in patients with severe asthma. As future risk is poorly perceived by controlled asthmatics, our review focuses on the risk in patients with ‘controlled’ severe asthma. Of note, it is likely that long-term OCS therapy may not prevent future asthma progression, including lung function decline. In addition, the risk of drug side effects increases even during low-dose OCS therapy. Thus, novel treatments are highly desirable for reducing future risks without any loss of asthma control.
Adrenal Cortex Hormones ; Asthma ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Lung ; Quality of Life

OBJECTIVETo evaluate the effects of asthma and inhaled corticosteroids (ICS) in children on the final adult height.

METHODSA search was performed to collect studies evaluating the relationship between asthma and ICS in children and the final adult height in PubMed, BCI, EMbase, Web of Science, CNKI and Wanfang databases, then a systemic review and Meta analysis were conducted.

RESULTSSix studies evaluating the relationship between childhood asthma and the final adult height were enrolled. Three of them indicated that the final adult height was not influenced by childhood asthma. Two of them suggested a mild effect, and the effect was correlated with severity of childhood asthma. One of them indicated that a lower final adult height related to childhhod asthma was found only in black females without a high school education. Four studies evaluating the relationship between ICS and the final adult height were included. Compared with the non-ICS treatment group, healthy control group and the target height, ICS treatment had no effects on the final adult height.

CONCLUSIONSChildhood asthma does not or only mildly decrease the final adult height. ICS treatment does not significantly affect the final adult height.

Administration, Inhalation ; Adrenal Cortex Hormones ; adverse effects ; Adult ; Asthma ; drug therapy ; Body Height ; drug effects ; Child ; Humans

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; adverse effects ; pharmacology ; therapeutic use ; Asthma ; drug therapy ; Child ; Drug Administration Routes ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Male

Etomidate and midazolam are the most popular drugs among the induction agents for emergent endotracheal intubation. The purpose of this study was to compare the incidence of adrenal insufficiency and mortality between the septic shock patients who received etomidate (ETM group) and those who received midazolam (MDZ group). Between November 2004 and September 2006, 65 patients were analyzed in this study. The hospital mortality rate was 36% in the ETM group (n=25) and 50% in the MDZ group (n=40), which was not statistically significant (p=0.269). The incidence of relative adrenal insufficiency was significantly higher in the ETM group than in the MDZ group (84% and 48%, respectively; p=0.003). On multivariate analysis, the use of etomidate was the only significant factor affecting the incidence of relative adrenal insufficiency (odds radio, 5.59; 95% confidence interval, 1.61- 19.4). In conclusion, we think that physicians who treat patients with septic shock should be aware that etomidate can cause adrenal insufficiency, and should start corticosteroids if etomidate is administered.
Adrenal Cortex Hormones/therapeutic use ; Adrenal Insufficiency/chemically induced/complications ; Aged ; Anesthetics, Intravenous/*adverse effects ; Etomidate/*adverse effects ; Female ; Humans ; *Intubation, Intratracheal ; Male ; Midazolam/*adverse effects ; Middle Aged ; Retrospective Studies ; Shock, Septic/complications/drug therapy/*mortality

OBJECTIVETo observe the clinical efficacy of modified Wuhua Decoction (WHD) on corticosteroid addictive dermatitis (CsAD) and in improving patients' facial skin barrier function.

METHODSSeventy-five patients were randomly assigned to two groups, the 38 in the treated group treated with WHD together with oral administration of levocetirizine tablet, while the 37 in the control group treated with levocetirizine tablet alone in the same way, 30 days as a course. Skin erythema dose (ED) and transepidermal water loss (TEWL) of patients were measured before and after treatment.

RESULTSFive cases in the treated group and 7 cases in the control group were dropped out. The total effective rate was 69.7% (23/33 cases) in the treated group and 10.0% (3/30 cases) in the control group respectively, with the score of objective symptoms reduced from 5.48 +/- 1.60 before treatment to 1.24 +/- 1.62 after treatment and the score of subjective symptoms reduced from 7.06 +/- 1.54 to 1.55 +/- 1.72 in the treated group, while in the control group, the two indexes reduced from 5.57 +/- 1.25 to 3.27 +/- 1.55 and from 6.77 +/- 1.36 to 3.07 +/- 1.36 respectively, showing significant difference between the two groups and the efficacy in the treated group was better than that in the control group (P <0.01). Skin ED decreased significantly in the treated group after treatment, and insignificantly in the control group. TEWL began to decrease on the 15th day in the treated group, while it was unchanged in the control group; on the 30th day, although a decrease was shown in both groups, its reduction was lower in the treated group (P <0.05).

CONCLUSIONWHD has significant clinical efficacy on CsAD, it could reduce the skin ED and quickly recover the injured facial skin barrier function.

Adrenal Cortex Hormones ; adverse effects ; Dermatitis, Contact ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Face ; Humans ; Skin Physiological Phenomena ; drug effects ; Substance-Related Disorders ; complications

Numerous disorders and etiologies may underlie increased eosinophil counts. Hypereosinophilia (HE) is defined as a peripheral blood eosinophil count greater than 1,500/mm3 and may be potentially harmful because of tissue damage. Hypereosinophilic syndrome (HES) also represents a heterogeneous disorder characterized by persistent HE with the evidence of organ dysfunction, clinical symptoms, or both caused by eosinophilia. The refining criteria and subclassification of HE and HES are currently being revised on cellular and molecular based diagnostic methods. Initial approaches focus on evaluating various underlying causes, including helminthic infections, adverse drug reactions, allergic diseases, and neoplastic diseases. When secondary causes of HE are excluded, the workup should proceed to the evaluation of primary/clonal bone marrow disease, including fip 1-like 1-platelet driven growth factor receptor alpha (FIP1L1-PDGFRA) mutation. Concurrently, if the patient has symptoms and signs, organ damage or dysfunction must be evaluated. Although, corticosteroids are the mainstay of therapy in confirmed HES, imatinib is considered a definitive treatment for FIP1L1-PDGFRA, platelet driven growth factor receptor beta rearranged HE and HES. In this article, we discuss recent advances in the classification of and practical approaches to HE and HES. In addition, we introduce several promising therapies for HE and HES.
Adrenal Cortex Hormones ; Blood Platelets ; Bone Marrow Diseases ; Classification* ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Eosinophils ; Helminths ; Humans ; Hypereosinophilic Syndrome ; Molecular Targeted Therapy ; Imatinib Mesylate

Secondary osteoporosis is a feature of rheumatoid arthritis (RA). In recent years, several attempts have been made to develop specific markers for monitoring connective tissue metabolism in arthritic diseases. Our purpose, in this study was to assess pyridinium crosslinks (PYD and DPYD) excretion in relation to the activity of RA (changes related to sulphasalazine treatment). Fourty premenopausal female patients with active RA (mean age; 36.0 7.2 years), 20 postmenopausal women with active RA (mean age; 60.0 6.8 years), 23 postmenopausal women with OA (mean age; 56.1 6.6 years) and 17 premenopausal healthy subjects (mean age; 28.3 4.28 years) were enrolled in our study. All of the 40 premenopausal female patients with active RA were given sulphasalazine. The mean follow up period for these patients was 10.3 1.1 months. In all of these patients, urine samples were collected both in the active and in the inactive periods. Urine PYD and DPYD levels were measured by ELISA. Urine PYD levels were significantly higher in the active period (14.01 3.16 nmol/mmol cr) than in the inactive (8.25 4.23 nmol/mmol cr) period in patients with premenopausal RA (p 0.05). Urine PYD levels were significantly high in postmenopausal active RA patients (19.06 3.26 nmol/mmol cr) compared to premenopausal active and ind inactive, postmenopausal inactive RA patients, osteoarthritis and healthy controls. Urine DPYD excretion was similar in patients with premenopausal RA in the active (7.46 2.13 nmol/mmol cr) and inactive periods (5.08 0.87 nmol/mmol cr) (p 0.05). In active premenopausal RA patients, a correlation was found between PYD excretion and RAI, ESR, CRP and functional capacity (r=0.5729 p 0.01, r=0.5953 p 0.01, r=0.6125 p 0.01 and r=0.6232, p 0.01 respectively). But in the inactive period, no such correlation was was evident. In disease activity parameters did not correlate with DPYD excretion in either the active or the inactive period. As a result, urine PYD excretion was significantly high in patients with active RA. During sulphasalazine treatment, urine PYD levels decreased. This is attributed to improvement in bone destruction.
Adrenal Cortex Hormones/adverse effects ; Adult ; Aged ; Amino Acids/*urine ; Arthritis, Rheumatoid/*urine ; Collagen/*urine ; Female ; Human ; Middle Age ; Osteoporosis/urine ; Sulfasalazine/*pharmacology

OBJECTIVETo evaluate the efficacy of compound Dixiong Decoction (地芎汤, a Chinese herbal decoction) on early prevention of radiation pneumonitis.

METHODSForty-six patients with non-small cell lung cancer who were planning to receive radiotherapy were randomly assigned to the treatment group treated with the compound Dixiong Decoction and the control group treated with a commonly used herbal decoction which has the effects of supplementing qi and nourishing yin, clearing heat and detoxifying at the time of radiotherapy. Primary measure was the incidence of radiation pneumonitis after radiotherapy. Secondary outcomes included Watters clinical radiographic physiologic (CRP) dyspnea score, the Radiation Therapy Oncology Group (RTOG) grading score, Karnofsky Performance Status (KPS) score, and the application of corticosteroids.

RESULTSThe incidence of radiation pneumonitis in the treatment group was 10.0%, while that in the control group was 26.3% (P=0.0032). The Watters CRP dyspnea score and RTOG grading score in the treatment group were significantly =lower than those in the control group (P<0.05). The KPS score in the treatment group was significantly higher than that in the control group (P<0.01). The dosage of corticosteroids was smaller with a shorter duration of therapy in the treatment group than that in the control group.

CONCLUSIONThe early application of the Chinese herbal decoction compound Dixiong Decoction can decrease the incidence of radiation pneumonitis, reduce the injury of the lung, and improve the life quality of the patients.

Adrenal Cortex Hormones ; administration & dosage ; Carcinoma, Non-Small-Cell Lung ; radiotherapy ; therapy ; Humans ; Incidence ; Lung Neoplasms ; radiotherapy ; therapy ; Pneumonia ; etiology ; therapy ; Prospective Studies ; Radiotherapy ; adverse effects

OBJECTIVETo evaluate the therapeutic efficacy of 3-year subcutaneous immunotherapy (SCIT) in asthmatic children allergic to mite.

METHODSNinety asthmatic children allergic to house dust mite (with or without allergic rhinitis) and aged 5-14 years were randomized into SCIT treatment group (n=45) and control group (n=45). The SCIT treatment group received SCIT combined with standardized treatment for asthma, while the control group received the standardized treatment alone. The therapeutic effects were assessed based on the daytime and nighttime symptom scores, mean daily doses of inhaled corticosteroids (ICS), skin prick test results, peak expiratory flows and total serum IgE at baseline and in the 3-year treatment.

RESULTSIn both groups, the daytime and nighttime symptom scores in the first, second, and third years of treatment were significantly lower than the baseline values (P<0.01), and the scores decreased year by year during the 3-year treatment (P<0.01). Also, the mean daily doses of ICS in the first, second, and third years of treatment were significantly lower than the baseline values (P<0.01), and the doses decreased year by year during the 3-year treatment (P<0.01). The mean daily dose was significantly lower in the SCIT treatment group than in the control group in the second and third years of treatment (P<0.05). After 3-year treatment, the SCIT treatment group had a significantly higher proportion of children who discontinued use of ICS due to remission of symptoms compared with the control group (29% vs 20%, P<0.05). At the end of the 3-year treatment, the total serum IgE was significantly lower than the baseline value in the SCIT treatment group (P<0.01), and it was significantly lower in the SCIT treatment group than in the control group (P<0.05).

CONCLUSIONSThree-year SCIT is effective in asthmatic children allergic to house dust mite and allows reduction in the dosage of ICS.

Adrenal Cortex Hormones ; administration & dosage ; Animals ; Asthma ; immunology ; therapy ; Child ; Desensitization, Immunologic ; adverse effects ; methods ; Female ; Humans ; Immunoglobulin E ; blood ; Injections, Subcutaneous ; Male ; Pyroglyphidae ; immunology

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; adverse effects ; therapeutic use ; Asthma ; drug therapy ; Child ; Dose-Response Relationship, Drug ; Humans ; Pediatrics ; trends