Chest
Volume 114, Issue 5, November 1998, Pages 1349-1356
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Clinicai Investigations: Asthma
Benefits of High-dose IV Immunoglobulin in Patients With Severe Steroid-Dependent Asthma

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Study objective

To determine the efficacy of IV immunoglobulin (IVIg) in severe asthma to reduce steroid requirements.

Design

Pre- and posttreatment measurements were analyzed using Dunnett's multiple comparison procedure.

Setting

Hospital clinical research center.

Patients

Eleven adolescents and adults with severe, steroid-dependent asthma enrolled over a 14-month period.

Interventions

IVIg was administered at a dose of 2 g/kg every 4 weeks for a total of seven infusions.

Measurements and results

Steroid requirements, pulmonary function including lung volumes, symptom scores, bone densitometry, and airway reactivity monitored by methacholine challenge were followed over the course of 7 months. A significant decrease in steroid usage was achieved. Despite substantial steroid reduction, the patients demonstrated improvement in their pulmonary function and symptom scores. The responses to methacholine challenge were unaffected by IVIg treatment.

Conclusions

IVIg provides a potentially important adjunctive therapy in severe asthma, reducing oral steroid requirements and steroid side effects without deterioration of lung function.

Section snippets

Subject Selection

Eleven severe steroid-dependent asthmatics were studied in an open label fashion. The subjects included five adolescents (three male, two female; age range, 12 to 16 years; mean age, 14 years) and six adult subjects (one man and five women; age range, 19 to 50 years; mean age, 38.5 years) All patients satisfied American Thoracic Society criteria for asthma.19 Steroid dependency was defined as the requirement for oral steroids in doses of ≥ 0.25 mg/kg/d for a minimum of 2 months prior to study

Patient Characteristics

Eleven subjects—five adolescents and six adults with chronic steroid-dependent asthma—were studied. All of the patients had had asthma for many years (a minimum of 6 years) and all had required oral glucocorticoids for a minimum of 3 years. In addition to severe asthma, the study group demonstrated many stigmata of steroid toxicity, including cushingoid features (nine patients), osteopenia/osteoporosis (nine patients), striae (seven patients), acne (four patients), cataracts (two patients),

Discussion

Advances in the understanding of the pathogenesis of asthma have led to an increased utilization of anti-inflammatory agents. Glucocorticoids represent the most potent drug currently available for this purpose.24 However, it has become evident that a subset of severe asthmatics continue to demonstrate poor disease control despite aggressive conventional therapy including the use of oral glucocorticoids. The subjects in the current study are examples of asthmatics whose medical care had reached

ACKNOWLEDGMENT

We are grateful to our many colleagues who participated in various aspects of this study, to Stanley Szefler, MD, for critical review of the manuscript, and to Miriam Buddinger, MD, for her support.

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  • Cited by (0)

    Supported by Bayer Pharmaceuticals, Inc.

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