Chest
Clinicai Investigations: AsthmaBenefits of High-dose IV Immunoglobulin in Patients With Severe Steroid-Dependent Asthma
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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