Systemic glucocorticoid

October 17, 2014 admin Health Care

It is possible that the high-dose glucocorticoid therapy administered in a controlled setting was sufficient to suppress any active eosinophilic inflammation, but the absence of neutrophils, generally refractory to glucocorticoid, was striking. Whether systemic glucocorticoid therapy was insufficient to inhibit inflammation, which eventually resulted in airway remodeling seen in these children, cannot be answered at present. Alternatively, airway remodeling may have occurred independently of airway inflammation, and in a glucocorticoid-insensitive manner. Fourth, the structural abnormalities Sildenafil online noted on endobronchial biopsy did not appear to predict the clinical response, at least while at NJMRC.

For example, case 4 required > 30 days of high-dose oral glucocorticoid therapy to achieve nearly normal lung function, while the lung function in case 5 improved to the normal range despite a complete reduction in the oral glucocorticoid dose in the face of similar findings on bronchial biopsy. Lastly, despite findings consistent with significant airway remodeling (basement membrane thickening and smooth-muscle hypertrophy/hyper-plasia), the majority of the patients, by the time of discharge, achieved normal FEV1 values associated with an accompanying decrease in diurnal variability. These observations argue against the concept that a grossly thickened basement membrane results in irreversible airflow obstruction, at least among children with severe asthma.

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Our findings contrast with those of Chetta who found the degree of basement membrane thickness to be associated with asthma severity in adults based on symptoms. Another study by the same group found statistically significant inverse correlations between basement membrane thickness and baseline FEV1, and provocative concentration of methacholine causing a 20% fall in FEV1 values, and a direct correlation with daily peak expiratory flow variability in adults with asthma. As compelling as these studies may appear, neither our results nor those of other investigators have confirmed such associations. For example, Wenzel studied a well-defined group of patients with mild, moderate, and severe asthma, and found no statistical difference in basement membrane thickness among the groups they studied.


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