Steroid-resistant asthma is asthma that is refractory to glucocorticoid treatment. Steroid-resistant asthma is diagnosed when the expected improvement is not achieved within two weeks of treatment with an appropriate dose of oral glucocorticosteroid. This is a very rare situation that occurs in every 1,000-10,000 of all cases. What causes steroid-resistant asthma? What is the treatment?

Steroid-resistant asthmais chronic severe asthma, resistant to treatment with high doses of inhaled and systemic glucocorticoids.

According to statistics, severe asthma, otherwise known as difficult or unresponsive, accounts for approximately 5-10 percent of all asthma cases. About half of these are steroid-resistant asthma, and the other half are steroid-resistant.

Steroid-resistant asthma - causes and risk factors

There are two forms of GKS resistance:

Type 1 - cytokine-induced resistance - occurs in 90-95% of sick

This is an acquired, but reversible, reduction in the ability of T-lymphocytes to bind GKS.

Type II - is associated with a genetic defect - mutation of the gene for the GKS receptor or genes modulating GKS functions and is irreversible.

Viral infections and smoking are risk factors for steroid-resistant asthma.

Worth knowing

Patient with asthma and GKS resistance

  • has had asthma for at least 5 years
  • is more often a woman
  • asthma affects other family members (both near and far)
  • shows greater bronchial hyperresponsiveness than other asthma patients
  • worst lung function indices are found in the morning

Steroid-resistant asthma - diagnosis

Steroid-resistant asthma is asthma that does not achieve an increase in FEV1 (forced expiratory volume in one second) above 15%. from baseline after using 20 mg of prednisolone for one week and 40 mg for the next week.

However, to diagnose steroid-refractory asthma, you must first rule out any diseases or factors that mask asthma and contribute to a poor response to glucocorticosteroids:

  • COPD
  • vocal cord dysfunction
  • gastro-refluxesophageal
  • chronic paranasal sinusitis
  • emotional factors
  • interactions of glucocorticosteroids with drugs and diseases that accelerate their excretion (rifampicin, antiepileptic drugs)
  • hyperthyroidism
  • constant exposure to allergens
  • no cooperation with the doctor

Steroid-resistant asthma - treatment

Glucocorticosteroids still remain the basic drug, but selected in such a way that they achieve greater concentration in the lungs. It is proposed to replace prednisolone with methylprednisolone or triamcinolone, which achieve greater concentration in the lungs, and to use inhalation steroids.

How to effectively treat steroid-resistant asthma:

1. Switch to an oral steroid with a higher lung deposition2. Use inhaled glucocorticoid treatment in an effective and possibly acceptable dose for the patient3. A patient with steroid-resistant asthma requires constant medical monitoring and proper education in the treatment process4. Continue treatment with long-acting beta2-agonists and other drugs from the group of so-called controllers, e.g. with theophylline, euphiline or leukotrienes5. In patients who require the use of high doses of systemic steroids, the following should be considered: cyclosporin A, methotrexate, immunoglobulins, anti-IgE monoclonal antibody

Source: Severe asthma, pneumonology.wum.edu.pl

Category:

Respiratory system