Effect of prolonged use of inhaled steroids on the cellular immunity of children with asthma☆,☆☆,★
Section snippets
Patients
Parameters of cellular immunity were studied in 40 asthmatic children from the Pediatric Pulmonary Clinics of Soroka Medical Center in Beer Sheva.
A group of 24 children (21 boys and 3 girls) with asthma, aged 3 to 18.5 years (mean age, 8.8 years) constituted the BDP group. Twenty-two of them were atopic as determined by positive skin test results. They were treated twice daily with inhaled BDP (Becotide-Glaxo) 200 to 600 μg/day (mean, 382 μg/day or 16.5 μg/kg/day) for a mean of 22.6 months
RESULTS
Sixty individuals (40 children with asthma and 20 healthy control subjects) were included in the study. Asthmatic children treated with BDP were compared with asthmatic children not treated with BDP. Fig. 1 shows that there were no significant differences in the differential WBC count regarding lymphocytes, neutrophils, and eosinophils ( p = 0.83). Mean total WBC count was 7595 in the BDP-treated group and 6972 in the non-BDP-treated group (7200 in normal control subjects). Polymorphonuclear
DISCUSSION
Chronic inflammation appears to be a major component in the pathogenesis of asthma. The inflammation of the respiratory epithelium results in swelling of mucous membranes, increased secretion of viscous mucus, and enhanced plugging of the medium- and small-sized airways. 19 The corticosteroids, which exhibit strong antiinflammatory effects, can reduce these processes and thus be of great use for patients with asthma. However, in addition to the antiinflammatory effect, systemically administered
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Cited by (24)
The use of inhaled corticosteroids in pediatric asthma: Update
2016, World Allergy Organization JournalCitation Excerpt :Several studies assessed the effects of high dose ICS on cell mediated immunity by using delayed type hypersensitivity skin testing as the measure of impaired cellular immunity and did not find any impairment compared with asthmatics on medications other than ICS [177] or healthy subjects [178]. The prolonged use of low dose ICS in asthmatic children has not been shown to affect cell mediated immunity either [179]. On the other hand, some recent studies have reported the association between ICS therapy and increased risk of pneumonia in adult COPD patients [180, 181].
Effect of high dose inhaled corticosteroids on cell mediated immunity in patients with asthma
2012, Allergologia et ImmunopathologiaCitation Excerpt :It is unclear at this time whether high dose inhaled corticosteroids also suppress cell mediated immunity. Studies addressing this issue have been conflicting thus far.32–34 Currently there are no data to suggest increased incidence or course of fungal, viral or bacterial infections with the use of inhaled corticosteroids.
Risk/benefit ratio of inhaled steroids [2] (multiple letters)
1996, Journal of PediatricsEffects of high-dose inhaled fluticasone propionate via spacer on cell-mediated immunity in healthy volunteers
2000, ChestCitation Excerpt :Thissuggests that although the absolute number of cells available may bealtered, the actual responses to antigenic stimulation is notsuppressed in subjects receiving recommended doses of inhaled steroids. In a study performed on asthmatics, a single dose of 400 μg, 1,600μg, or 800 μg of inhaled BDP in divided doses did not significantlysuppress total lymphocyte count; however, the investigators did notextend their study beyond 24 h.30 Levy etal32 demonstrated no effect of inhaled BDP on CMI(assessed tritiated thymidine incorporation) in asthmatic childrenreceiving BDP for a mean period of 22.6 months. The dose of inhaledsteroid used in this study was comparatively small (from 200 to 600μg/d), and no baseline studies were performed.
Risk of herpes zoster among patients with chronic obstructive pulmonary disease: A population-based study
2011, CMAJ. Canadian Medical Association JournalCitation Excerpt :Although oral corticosteroids have frequently been reported to be associated with the occurrence of herpes zoster, the link between inhaled corticosteroids and varicella-zoster virus reactivation is unclear.4,5 Although recent evidence suggests that inhaled corticosteroids suppress local immunity and increase the risk of pneumonia and pulmonary tuberculosis among patients with COPD,23,24 the impact of inhaled corticosteroids on systemic immunity remains controversial.25 Abzug and Cotton26 have reported severe varicella infection after use of intranasal corticosteroids, and Choong and colleagues27 reported severe varicella infection after use of inhaled corticosteroids.
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From the Departments of aPediatrics, bClinical Immunology Laboratory, cImmunology and Microbiology, and dEpidemiology, Soroka Medical Center of Kupat Holim and The Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; and e Department of Statistics, Colorado State University, Denver.
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Reprint requests: Jacov Levy, MD, Department of Pediatrics, Soroka Medical Center, P.O. Box 151, Beer Sheva, Israel, 84101.
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0091-6749/95 $3.00 + 0 1/1/62022