Effect of combined glucocorticoid therapy on bronchial asthma dynamics

Main Article Content

Ekaterina Batrakova
Oxana Kartashova
Liudmila Babaskina
Olga Pashanova

Keywords

Bronchial Asthma, Exacerbation, Glucocorticosteroids, Inhalation, Peak Flow Rate, Therapy

Abstract

This work is aimed to compare the effectiveness of parenteral and inhalation bronchial asthma treatment in combination with glucocorticosteroids and bronchodilators. The study was conducted in 2020 in Botkin City Clinical Hospital (Moscow, the Russian Federation). Case histories of 106 patients diagnosed with bronchial asthma exacerbation of moderate severity were analyzed. Patients were divided into two equal groups based on the therapy method: (1) Group 1 received systemic glucocorticosteroids parenterally in combination with inhalation glucocorticosteroids; (2) Group 2 received systemic glucocorticosteroids parenterally, but inhalation therapy was performed with a nebulizer. Clinical manifestations of bronchial asthma have been recorded. During hospital admission, the breath rate was 22.0 for Group 1 and 21.5 for Group 2, P ≥ 0.05, and heart rates were 93.0 and 92.5, respectively (P ≥ 0.05). All indices (blood saturation, breath rate, peak output rate) in Group 1 remained unchanged 4 h after the start of the therapy, while in Group 2, peak flow rate changed to 53.5% with a median increase of 72.0 ml over 4 h, P ≤ 0.05. On Day 3, patients of Group 1 demonstrated a peak flow rate of 59.5%, P ≤ 0.05, and on Day 10, patients of Group 2 had a peak output rate of 53.0 and 59.5%, respectively (P ≤ 0.05). Systemic glucocorticoids were eliminated in 47 patients of Group 1 and in all patients of Group 2. The treatment tactics applied in Group 2 resulted in faster and more significant improvement in patients diagnosed with bronchial asthma exacerbation. Both treatment regimens showed high results.

Abstract 74 | PDF Downloads 29 HTML Downloads 7 XML Downloads 2

References

1. Henderson I, Caiazzo E, McSharry C, Guzik TJ, Maffia P. Why do some asthma patients respond poorly to glucocorticoid therapy? Pharmacol Res. 2020;160:105189. 10.1016/j.phrs.2020.105189

2. Salah KM, Al Shafie MM, Gaber OA, Awad MT. Association between glucocorticosteroid receptor (NR3C1) gene polymorphism and bronchial asthma in children. Zagazig Univ Med J. 2020;26(1):123–31. 10.21608/zumj.2019.11975.1204

3. Palumbo ML, Prochnik A, Wald MR, Genaro AM. Chronic stress and glucocorticoid receptor resistance in asthma. Clin Ther. 2020;42(6):993–1006. 10.1016/j.clinthera.2020.03.002

4. Shabani D, Mustafa L, Islami P, Iljazi A, Dauti A, Islami H. Effect of Glucocorticoids following application of Adenosine receptor blockers in patients with chronic obstructive bronchitis and bronchial asthma. Open Access Maced J Med Sci. 2020;8(B):597–601. 10.3889/oamjms.2020.3894

5. Ora J, Calzetta L, Matera MG, Cazzola M, Rogliani P. Advances with glucocorticoids in the treatment of asthma: State of the art. Expert Opin Pharmacother. 2020;21(18):2305–16. 10.1080/14656566.2020.1807514

6. Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: A roadmap to asthma control. Eur Respir J. 2015;46(3):622–39. 10.1183/13993003.00853-2015

7. GINA Report. Global Strategy for Asthma Management and Prevention 2019 [Internet]. Accessed 25 May 2021. Available from: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf

8. Adcock IM, Mumby S. Glucocorticoids. Handb Exp Pharmacol. 2017;237:171–96. 10.1007/164_2016_98

9. Geng W, Batu W, You S, Tong Z, He H. High-flow nasal cannula: A promising oxygen therapy for patients with severe bronchial asthma complicated with respiratory failure. Can Respir J. 2020;2020:2301712. 10.1155/2020/2301712

10. Ruangsomboon O, Limsuwat C, Praphruetkit N, Monsomboon A, Chakorn T. Nasal high-flow oxygen versus conventional oxygen therapy for acute severe asthma patients: A pilot randomized controlled trial. Acad Emerg Med. 2021;28(5):530–41. 10.1111/acem.14187

11. Ingawale DK, Mandlik SK. New insights into the novel anti-inflammatory mode of action of glucocorticoids. Immunopharmacol Immunotoxicol. 2020;42(2):59–73. 10.1080/08923973.2020.1728765

12. Montaño LM, Flores-Soto E, Sommer B, Solís-Chagoyán H, Perusquía M. Androgens are effective bronchodilators with anti-inflammatory properties: A potential alternative for asthma therapy. Steroids. 2020;153:108509. 10.1016/j.steroids.2019.108509

13. O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled combined budesonide–formoterol as needed in mild asthma. N Engl J Med. 2018;378(20):1865–76. 10.1056/NEJMoa1715274

14. Dunican EM, Fahy JV. Asthma and corticosteroids: Time for a more precise approach to treatment. Eur Respir Soc. 2017;49(6):1701167. 10.1183/13993003.01167-2017

15. Kadmiel M, Cidlowski JA. Glucocorticoid receptor signaling in health and disease. Trends Pharmacol Sci. 2013;34(9):518–30. 10.1016/j.tips.2013.07.003

16. Barnes PJ. Glucocorticosteroids: Current and future directions. Br J Pharmacol. 2011;163(1):29–43. 10.1111/j.1476-5381.2010.01199.x

17. Westergaard CG, Porsbjerg C, Backer V. Emerging corticosteroid agonists for the treatment of asthma. Expert Opin Emerg Drugs. 2015;20(4):653–62. 10.1517/14728214.2015.1061503

18. Pelaia G, Vatrella A, Busceti MT, Fabiano, F, Terracciano R, Matera MG, et al. Molecular and cellular mechanisms underlying the therapeutic effects of budesonide in asthma. Pulm Pharmacol Ther. 2016;40:15–21. 10.1016/j.pupt.2016.07.001

19. Rogliani P, Matera MG, Facciolo F, Page C, Cazzola M, Calzetta L. Beclomethasone dipropionate, formoterol fumarate and glycopyrronium bromide: Synergy of triple combination therapy on human airway smooth muscle ex vivo. Br J Pharmacol. 2020;177(5):1150–63. 10.1111/bph.14909

20. Tamm M, Richards DH, Beghé B, Fabbri L. Inhaled corticosteroid and long-acting β2-agonist pharmacological profiles: Effective asthma therapy in practice. Respir Med. 2012;106:S9–19. 10.1016/S0954-6111(12)70005-7

21. Daley-Yates PT. Inhaled corticosteroids: Potency, dose equivalence and therapeutic index. Br J Clin Pharmacol. 2015;80(3):372–80. 10.1111/bcp.12637

22. Cohen J, Postma DS, Douma WR, Vonk JM, De Boer AH, Ten Hacken NHT. Particle size matters: Diagnostics and treatment of small airways involvement in asthma. Eur Respir J. 2011;37(3):532–40. 10.1183/09031936.00204109

23. O’Byrne PM, Jenkins C, Bateman ED. The paradoxes of asthma management: Time for a new approach? Eur Respir J. 2017;50(3):1701103. 10.1183/13993003.01103-2017

24. Orlova AA, Strugar J, Shtark OYu, Zhukov VA, Luzhanin VG, Povydysh MN. Use of metabolomic approaches in analysis of medicinal plants and phytopreparations (review). Drug Dev Reg. 2021;10(1):97–105.

25. Calzetta L, Matera MG, Facciolo F, Cazzola M, Rogliani P. Beclomethasone dipropionate and formoterol fumarate synergistically interact in hyperresponsive medium bronchi and small airways. Respir Res. 2018;19(1):65. 10.1186/s12931-018-0770-7

26. Bateman ED, Reddel HK, O’Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As-needed budesonide–formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378(20):1877–87. 10.1056/NEJMoa1715275

27. Kalabin GA, Vasil’ev VG, Ivlev VA. Possibilities of low-field NMR spectrometers in screening the content of medicinal substances. Drug Dev Reg. 2021;10(1):16–22.

28. Beasley R, Holliday M, Reddel HK, Braithwaite I, Ebmeier S, Hancox RJ, et al. Controlled trial of budesonide–formoterol as needed for mild asthma. N Engl J Med. 2019;380(21):2020–30. 10.1056/NEJMoa1901963

29. Zhou P, Xi L, He H, Zhang B, Li Y. A comparison of efficacy and safety of complementary and alternative therapies for children with asthma: A protocol for systematic review and meta analysis. Medicine. 2021;100(11):e24946. 10.1097/MD.0000000000024946

30. Rogliani P, Ritondo BL, Ora J, Cazzola M, Calzetta L. SMART and as-needed therapies in mild-to-severe asthma: A network meta-analysis. Eur Respir J. 2020;56(3):2000625. 10.1183/13993003.00625-2020

31. Reddel HK, Busse WW, Pedersen S, Tan WC, Chen YZ, Jorup C, et al. Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: A post-hoc efficacy analysis of the START study. Lancet. 2017;389(10065):157–66. 10.1016/S0140-6736(16)31399-X

32. Lazarus SC, Krishnan JA, King TS, Lang JE, Blake KV, Covar R, et al. Mometasone or tiotropium in mild asthma with a low sputum eosinophil level. N Engl J Med. 2019;380(21):2009–19. 10.1056/NEJMoa1814917

33. Schleich FN, Seidel L, Sele J, Manise M, Quaedvlieg V, Michils A, et al. Exhaled nitric oxide thresholds associated with a sputum eosinophil count≥ 3% in a cohort of unselected patients with asthma. Thorax. 2010;65(12):1039–44. 10.1136/thx.2009.124925

34. Truong-Thanh T, Vo-Thi-Kim A, Vu-Minh T, Truong-Viet D, Tran-Van H, Duong-Quy S. The beneficial role of FeNO in association with GINA guidelines for titration of inhaled corticosteroids in adult asthma: A randomized study. Adv Med Sci. 2020;65(2):244–51. 10.1016/j.advms.2020.03.001

35. Schleich F, Brusselle G, Louis R, Vandenplas O, Michils A, Pilette C, et al. Heterogeneity of phenotypes in severe asthmatics. The Belgian severe asthma registry (BSAR). Respir Med. 2014;108(12):1723–32. 10.1016/j.rmed.2014.10.007

36. Long B, Lentz S, Koyfman A, Gottlieb M. Evaluation and management of the critically ill adult asthmatic in the emergency department setting. Am J Emerg Med. 2021;44:441–51. 10.1016/j.ajem.2020.03.029

37. Pu Chu EC, Chakkaravarthy DM, Huang KHK, Ho VWK, Lo F-S, Bhaumik A. Changes in radiographic parameters following chiropractic treatment in 10 patients with adolescent idiopathic scoliosis: A retrospective chart review. Clin Pract. 2020;10(3):70–73. 10.4081/cp.2020.1258

38. Volmer T, Effenberger T, Trautner C, Buhl R. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: A focused review of the impact data in the literature. Eur Respir J. 2018;52(4):1800703. 10.1183/13993003.00703-2018

39. Agusti A, Fabbri LM, Singh D, Vestbo J, Celli B, Franssen FM, et al. Inhaled corticosteroids in COPD: Friend or foe? Eur Respir J. 2018;52(6):1801219.10.1183/13993003.01219-2018

40. Liang Y, Mak JC. Inhaled therapies for asthma and chronic obstructive pulmonary disease. Curr Pharm Des. 2021;27(12):1469–81. 10.2174/1389201021666201126144057

41. Wu K, Michalski A, Cortes D, Rozenberg D, Mathur S. Glucocorticoid-induced myopathy in people with asthma: A systematic review. J Asthma. 2021;1:1–14. 10.1080/02770903.2021.1926488