The small airways have been neglected for many years, but interest in the topic has been rekindled with recent advances in measurement techniques to assess this region and also the ability to deliver therapeutics to the distal airways. Current levels of disease control in asthmatic patients remain poor and there are several contributory factors including; poor treatment compliance, heterogeneity of asthma phenotypes and associated comorbidities. However, the proposition that we may not be targeting all the inflammation that is present throughout the whole respiratory tree may also be an important factor. Indeed decades ago, pathologists and physiologists clearly identified the importance of small airways dysfunction in asthmatic patients. With improved inhaler technology to deliver drug to target the whole respiratory tree and more sensitive measures to assess the distal airways, we should certainly give greater consideration to treating the small airway region when seeing our asthmatic patients in clinic. The aim of this review is to address the relevance of small airways dysfunction in the daily clinical management of patients with asthma. In particular the role of small particle aerosols in the management of patients with asthma will be explored.
Adrenal Cortex Hormones ; Aerosols ; Asthma* ; Comorbidity ; Compliance ; Humans ; Inflammation ; Inhalation ; Nebulizers and Vaporizers ; Pharmacology ; Phenotype ; Physiology ; Population Characteristics

OBJECTIVE: To observe histopathologic changes of irradiated guinea pigs' nasal mucosa treated with intranasal corticosteroids and to study the radioprotective effect of intranasal corticosteroids. METHOD: Fifty health guinea pigs nasal parts were performed irradiation by the WDVE-6MeV linear accelerator. They had accepted 5 Gy one time per week for three weeks through X-ray irradiating to establish the animal irradiation injury model. After that, they were divided into 2 groups randomly: the control group and the administration group and each group had 25 guinea pigs. The administration group received intranasal corticosteroids on the second day after three weeks irradiation, 5 animals per one group were sacrificed randomly at 1 W, 1 M, 2 M, 3 M, 4 M after administration, the histopathologic changes were observed under optical, scanning electron and transmission electron microscope respectively. RESULT: Using intranasal corticosteroids after irradiation, the early inflammatory reaction of the administration group was milder than the control group. With the drug being given constantly, the recovery of epithelial cell with irradiated damage was accelerated and the coverage rate of cilia went up obviously; After four months, the coverage rate of cilia had risen to 72.9%; But, for the control group, the coverage rate of cilia is only 50.2%. The atrophy of submucosal glandular organ was lessened and they displayed some extent secretory function. The reparation was accelerated as time went by. CONCLUSION Irradiation brought about serious injury on guinea pigs' nasal mucosa. But, the injury was lessen after using intranasal corticosteroids. Intranasal corticosteroids play the role of radioprotection for the irradiated nasal mucosa.
Adrenal Cortex Hormones ; pharmacology ; Animals ; Guinea Pigs ; Nasal Mucosa ; drug effects ; pathology ; radiation effects ; Radiation Injuries, Experimental ; prevention & control

Many trials have been done on steroid-resistant atopic dermatitis. Recently, intravenous immune globulin (i.v.IG) was reported to be effective in the treatment of steroid-dependent atopic dermatitis. The aim of this study was to clarify whether i.v.IG therapy is effective in steroid-resistant atopic dermatitis. Forty-one steroid-resistant atopic dermatitis patients were tested in this study. Patients who weighed less than 30 kg were administered 500 mg/kg of i.v.IG. Patients who weighed 30 kg or more were administered 15 g of i.v.IG. Patient evaluations and laboratory tests with peripheral bloods such as eosinophil percentages and serum IgE levels were performed at days 0, 1, 7, and 21. In the present study, patients who responded to i.v.IG therapy were classified as Group A. Twelve patients who showed transient effects with lower clinical significance were classified as Group B (29.3%). Remaining 12 patients (29.3%) in Group C showed no improvement at all. Serum IgE levels and blo eosinophil percentages were markedly decreased in Group A. I.v.IG therapy may be recommended in the treatment of atopic dermatitis with extremely high serum IgE levels.
Adolescence ; Adrenal Cortex Hormones/pharmacology* ; Child ; Dermatitis, Atopic/therapy* ; Dermatitis, Atopic/immunology ; Drug Resistance ; Eosinophils/cytology ; Female ; Human ; IgE/blood ; Immunoglobulins, Intravenous/therapeutic use* ; Immunotherapy ; Male

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

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

OBJECTIVE: To study the expression of Eotaxin and Eotaxin-2 in nasal polyp and observe the effects of steroids on Eotaxin and Eotaxin-2 in nasal polyps. METHOD: The SP immunohistochemical method was applied to explore the expression of Eotaxin and Eotaxin-2 in nasal polyps before and after systemic corticosteroids therapy; the optical density of positive cells were measured by using HPIAL-2000 image-conduct system. RESULT: The expression of Eotaxin and Eotaxin 2 were positive in mucosal epithelia, vascular endothelial, glandular epithelium, and inflammatory cells. After corticosteroids use, the number of eosinophils, the expression of Eotaxin in mucosal epithelia, inflammatory cells and vascular endothelial, and the expression of Eotaxin-2 in mucosal epithelia were significantly decreased (P<0.05). The steroids affected the expression of on Eotaxin-2 in mucosal epithelia of nasal polyps mostly. CONCLUSION 1) The expression of Eotaxin and Eotaxin-2 in nasal polyp are positive. 2) The effects of steroid on the nasal polyps may depend on decreasing the infiltration of eosinophils and the expression of Eotaxin and Eotaxin-2.
Adrenal Cortex Hormones ; pharmacology ; Adult ; Chemokine CCL11 ; metabolism ; Chemokine CCL24 ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Nasal Mucosa ; drug effects ; metabolism ; Nasal Polyps ; drug therapy ; metabolism ; Young Adult

The objectives of this study were to assess the ultrasonographic (US) findings in patients with knee osteoarthritis (OA) with pes anserinus tendinitis or bursitis (PATB) syndrome and to determine the correlation between the US findings and the response to local corticosteroid injection. We prospectively studied 26 patients with knee OA with clinically diagnosed PATB syndrome. A linear array 7 MHz transducer was used for US examination of the knee. Seventeen patients were injected locally with tramcinolone acetonide in the anserine bursa area. Response to local corticosteroid injection was evaluated by pain visual analog scale (VAS), Western Ontario and MacMaster (WOMAC) osteoarthritis index and Global patient/physician assessment using Likert scale. On US examination, only 2 patients (8.7%) showed evidence of PATB. Pain VAS, WOMAC pain index and WOMAC physical function index improved significantly after corticosteroid injection. Global patient assessment revealed that 2 patients showed best response, 6 good, 1 fair, 8 the same, and none worse. It is of note that the 2 patients who showed the best response were those who showed US evidence of PATB. This finding shows that US can serve as a useful diagnostic tool for guiding treatment in PATB syndrome of OA patients.
Adrenal Cortex Hormones/*pharmacology ; Aged ; Bursitis/ultrasonography ; Female ; Glucocorticoids/pharmacology ; Humans ; Knee/*pathology ; Male ; Middle Aged ; Osteoarthritis, Knee/*diagnosis/drug therapy/*ultrasonography ; Pain ; Pain Measurement ; Research Support, Non-U.S. Gov't ; Tendinitis/pathology/ultrasonography ; Treatment Outcome

Adrenal Cortex Hormones ; pharmacology ; therapeutic use ; Adult ; Female ; Fluorescent Antibody Technique ; Follow-Up Studies ; Glomerulonephritis ; drug therapy ; pathology ; Glycosides ; pharmacology ; therapeutic use ; Humans ; Kidney ; drug effects ; pathology ; ultrastructure ; Tablets ; Tripterygium ; chemistry

Administration, Inhalation ; Adrenal Cortex Hormones ; pharmacology ; Asthma ; drug therapy ; metabolism ; Child ; Child, Preschool ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Male ; Theophylline ; pharmacokinetics ; pharmacology ; Treatment Outcome

OBJECTIVETo clarify the relationship between the expression of alpha- and beta-isoform of corticosteroid receptors (CS) in peripheral blood mononuclear cell (PBMC) and response to corticosteroid in patients with allergic rhinitis (AR).

METHODSSemi-quantitative RT-PCR was used to detect the expression of CS-alpha, beta in PBMC in patients with AR and to observe the different responses to corticosteroid in controls. Immunocytochemical assay was used to detect the expression of protein of CS-alpha and CS-beta.

RESULTS1) The expression of CS-alpha mRNA was detected in the sensitive group and the resistant group of patients with AR and the controls with CS-alpha/GAPDH mRNA (x +/- s) 1.15 +/- 0.75, 1.63 +/- 0.78, 1.27 +/- 0.51 respectively. 2) The expression of CS-beta mRNA in PBMC in the resistant group of patients with AR was significantly higher than that in the sensitive group and the controls (P < 0.05), with CS-beta/GAPDH mRNA 1.42 +/- 0.73, 0.82 +/- 0.59, 0.80 +/- 0.68 respectively. 3) The number of CS-beta-positive PBMC in the resistant group was significantly higher than that in the sensitive group and the controls (P < 0.01), with the number of CS-beta-positive PBMC 28.8% +/- 9. 9%, 5.9% +/- 3.2%, 5.5% +/- 6.8% respectively.

CONCLUSIONSIt is shown that the excessive expression of CS-beta may serve as a novel predictor of corticosteroid resistance in patients with AR.

Adolescent ; Adrenal Cortex Hormones ; pharmacology ; Adult ; Aged ; Case-Control Studies ; Drug Resistance ; Female ; Humans ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; Prognosis ; Protein Isoforms ; metabolism ; RNA, Messenger ; genetics ; Receptors, Steroid ; metabolism ; Rhinitis, Allergic, Perennial ; drug therapy ; metabolism ; Young Adult