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

BACKGROUNDCoronary artery lesions (CALs) are known to be the main complication in children with Kawasaki disease (KD). Instead of intravenous immunoglobulin (IVIG), corticosteroid therapy has been accepted to be used for children with KD who are unresponsive to IVIG. This study aimed to evaluate risk factors for CALs in children with KD.

METHODSWe retrospectively reviewed the clinical records of 2331 children with KD from January 2005 to December 2014. To identify the independent risk factors for CALs, multivariable logistic regression models were constructed using significant variables identified from univariate logistic regression analysis.

RESULTSThe incidence of CALs was 36.0% (840 of 2331), including 625 (26.8%) coronary artery dilations and 215 (9.2%) coronary artery aneurysms (CAAs). Multivariable logistic regression analysis identified that male, incomplete KD, longer fever duration, and C-reactive protein (CRP) >100 mg/L were independent risk factors for coronary artery dilatations. On the other hand, male, incomplete KD, longer fever duration, prolonged days of illness at the initial treatment, corticosteroid therapy, sodium ≤133 mmol/L, and albumin <35 g/L were the independent risk factors for CAAs. In addition, corticosteroid therapy, prolonged days of illness at the initial treatment, and albumin <35 g/L were the independent risk factors for giant CAAs.

CONCLUSIONSCALs might be associated with male sex, incomplete KD, longer fever duration, prolonged days of illness at the initial treatment, albumin <35 g/L, sodium ≤133 mmol/L, CRP >100 mg/L, and corticosteroid therapy. Corticosteroid therapy was an independent risk factor for CAAs and giant CAAs. Thus, corticosteroids should be used with caution in the treatment of KD with the risk for CALs.

Adolescent ; Adrenal Cortex Hormones ; adverse effects ; Child, Preschool ; Coronary Aneurysm ; chemically induced ; Female ; Humans ; Infant ; Logistic Models ; Male ; Mucocutaneous Lymph Node Syndrome ; drug therapy ; Retrospective Studies

BACKGROUNDClarifying the risk factors for postoperative complications and taking measures to minimize these complications will improve the outcomes in patients with ulcerative colitis (UC). This study aimed to systemically explore the risk factors for short-term postoperative complications in Chinese UC patients undergoing ileocolorectal surgery.

METHODSForty-nine UC patients undergoing proctocolectomy or ileostomy were retrospectively enrolled. Univariate and multivariate logistic regression analyses were conducted to reveal the risk factors among the clinical, laboratory, and surgical variables as well as preoperative medications.

RESULTSTwenty-two (44.9%) patients who suffered from at least one short-term postoperative event had more severe hypoalbuminemia (P = 0.007) and an increased prevalence of preoperative corticosteroid usage (prednisone more than 20 mg daily or equivalent) for more than 6 weeks (59.1% vs. 25.9%, P = 0.023) compared with patients without short-term postoperative complications. Based on the multivariate logistic regression analysis, the odds ratio (95% confidence interval) values of these two risk factors were 1.756 (0.889-3.470, P = 0.105) and 3.233 (0.916-11.406, P = 0.068), respectively. In 32 severe UC patients, prolonged preoperative hospital stay worsened the short-term postoperative outcomes.

CONCLUSIONSPreoperative corticosteroids usage and hypoalbuminemia worsened the short-term outcomes following ileocolorectal surgery in Chinese UC patients.

Adrenal Cortex Hormones ; adverse effects ; Adult ; Colectomy ; Colitis, Ulcerative ; surgery ; Female ; Humans ; Hypoalbuminemia ; complications ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors

Acute graft-versus-host disease (aGVHD) is a common complication after allogeneic hematopoietic stem-cell transplantation. Despite improvements in understanding of transplant immunology, aGVHD remains to be a major cause of mortality for patients after allogeneic hematopoietic stem-cell transplantation. While systemic corticosteroid is standard primary therapy for aGVHD, there is no established standard treatment for patients in the steroid-refractory setting. Over the past decade, monoclonal antibodies, biologic engineering products, and chemotherapeutics with immunomodulatory effects are being used as novel therapies in this disease. Many of these agents, such as mycophenolate mofetil, anti-tumor necrosis factor antibodies, and anti-interleukin-2Ralpha-chain antibodies, have demonstrated promising activity in steroid-refractory aGVHD. But long-term survival remains poor due to a high incidence of infections. The key to improving aGVHD outcomes may, in fact, rest upon successful initial therapy, and timely taper corticosteroids to promote immune reconstitution. Clinical trials combining these newer agents with systemic corticosteroids as initial treatment are under way. In this article some new treatments for acute aGVHD are recommend and summarized.
Adrenal Cortex Hormones ; therapeutic use ; Antibodies, Monoclonal ; therapeutic use ; Graft vs Host Disease ; therapy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans

Antithymocyte globulin (ATG) has long been used for immune-induction and anti-rejection treatments for solid organ transplantations. To date, few cases of ATG-induced acute respiratory distress syndrome (ARDS) have been published. Here, we present a case of ARDS caused by a single low-dose of ATG in a renal transplant recipient and the subsequent treatments administered. Although the patient suffered from ARDS and delayed graft function, he was successfully treated. We emphasize that the presence of such complications should be considered when unexplained respiratory distress occurs. Early use of corticosteroids, adjustment of immunosuppressive regimens, and conservative fluid management, as well as empiric antimicrobial therapies, may be effective strategies for the treatment of ARDS caused by ATG.
Adrenal Cortex Hormones ; therapeutic use ; Adult ; Antilymphocyte Serum ; adverse effects ; Humans ; Kidney Transplantation ; Male ; Respiratory Distress Syndrome, Adult ; chemically induced ; drug therapy