The Use of Glucocorticoids in the Treatment of Acute Asthma Exacerbations

Asthma is a chronic respiratory disease that is prevalent worldwide. It is considered as a major cause of morbidity and a main contributor to the high health care expenditure especially in developed countries (Subbarao et al, 2009). There are two major pathological features in asthmatics’ airways, inflammation and hyperresponsiveness. These features are interrelated but not totally dependent on each other. Airway inflammatory changes include increased airway mucus secretions, airway wall edema, inflammatory cellular infiltrates, epithelial cell damage, smooth muscle hypertrophy, and submucosal fibrosis (Bergeron et al, 2009). The cellular infiltrates are mainly composed of eosinophils, neutrophils, mast cells, lymphocytes, basophils and macrophages. The ratio of these cells may widely vary between patients pointing to asthma heterogeneity (Holgate, 2008). Overall, asthma can be divided into eosinophilic, neutrophilic, and pauci-granulocytic phenotypes. The eosinophilic phenotype is characterized by predominant eosinophilic infiltration of the airways. Patients tend to be allergic, have asthma triggered by exposure to allergens and tend to respond well to glucocorticoids. The neutrophilic phenotype is characterized by predominant neutrophil infiltration of the airways. Patients tend to have severe, more aggressive, poorly controlled asthma, or acute asthma triggered by viral infection. They usually do not respond to glucocorticoids as good as the eosinophilic type. In the pauci-granulocytic phenotype neutrophils and eosinophils are almost absent (Holgate, 2008).

• Publication year

  2012

• Venue

  Unknown venue

• Publication date

  2012-11-28

• Fields of study

  Medicine

• Identifiers
  DOI 10.5772/53221
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

• The Patient with Asthma in the Emergency Department

  2012cited by this paper
• Asthma outcomes: exacerbations.

  2012cited by this paper
• Evidence for a Causal Relationship Between Allergic Sensitization and Rhinovirus Wheezing in Early Life

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• Addition of intravenous aminophylline to inhaled beta(2)-agonists in adults with acute asthma.

  2012cited by this paper
• Inhaled steroids for acute asthma following emergency department discharge.

  2012cited by this paper
• Asthma exacerbations: Origin, effect, and prevention

  2011cited by this paper
• Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial.

  2011cited by this paper
• Remodeling in asthma.

  2011cited by this paper
• Effect of addition of single dose of oral montelukast to standard treatment in acute moderate to severe asthma in children between 5 and 15 years of age: a randomised, double-blind, placebo controlled trial

  2010cited by this paper
• A randomized placebo-controlled study of intravenous montelukast for the treatment of acute asthma.

  2010cited by this paper
• Genomic and non-genomic actions of glucocorticoids in asthma

  2010cited by this paper
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  2010cited by this paper
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• Can montelukast shorten prednisolone therapy in children with mild to moderate acute asthma? A randomized controlled trial.

  2009cited by this paper
• Asthma: epidemiology, etiology and risk factors

  2009cited by this paper
• Effects of inhaled versus systemic corticosteroids on exhaled nitric oxide in severe acute asthma.

  2009influential reference
• Preemptive Use of High-Dose Fluticasone for Virus-Induced Wheezing in Young Children

  2009cited by this paper
• PPARα blocks glucocorticoid receptor α-mediated transactivation but cooperates with the activated glucocorticoid receptor α for transrepression on NF-κB

  2009cited by this paper
• Pharmacogenetics of asthma

  2009cited by this paper
• Novel insights into mechanisms of glucocorticoid action and the development of new glucocorticoid receptor ligands.

  2008cited by this paper
• Ophthalmologic findings in children with asthma receiving inhaled budesonide.

  2008cited by this paper
• Can inhaled corticosteroids influence the natural history of asthma?

  2008cited by this paper
• Genomic and nongenomic effects of glucocorticoids

  2008influential reference
• The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers.

  2008cited by this paper
• Glucocorticoid signaling: a nongenomic mechanism for T-cell immunosuppression.

  2007cited by this paper
• Levalbuterol for asthma: A better treatment?

  2007cited by this paper
• Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

  2007cited by this paper
• Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program.

  2007cited by this paper
• Real-world Evaluation of Asthma Control and Treatment (REACT): findings from a national Web-based survey.

  2007cited by this paper
• High-Dose Inhaled Fluticasone Does Not Replace Oral Prednisolone in Children With Mild to Moderate Acute Asthma

  2007cited by this paper
• High-Dose Inhaled Fluticasone Does Not Replace Oral Prednisolone in Children With Mild to Moderate Acute Asthma

  2006cited by this paper
• Rapid effects of inhaled corticosteroids in acute asthma: an evidence-based evaluation.

  2006cited by this paper
• Cochrane review: Holding chambers (spacers) versus nebulisers for beta‐agonist treatment of acute asthma

  2006influential reference
• Inhaled corticosteroids: effects on the airway vasculature in bronchial asthma

  2006cited by this paper
• Prevalence of viral respiratory tract infections in children with asthma

  2006cited by this paper
• Single-Dose Oral Dexamethasone in the Emergency Management of Children With Exacerbations of Mild to Moderate Asthma

  2006cited by this paper
• Update on glucocorticoid action and resistance.

  2006cited by this paper
• Characterization of within-subject responses to fluticasone and montelukast in childhood asthma.

  2005cited by this paper
• Effects of glucocorticoids on the hypothalamic-pituitary-adrenal axis in children and adults.

  2005cited by this paper
• Rapid immunosuppressive effects of glucocorticoids mediated through Lck and Fyn.

  2005cited by this paper
• Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis

  2005cited by this paper
• Comparison of inhaled fluticasone with intravenous hydrocortisone in the treatment of adult acute asthma.

  2005cited by this paper
• Acute effect of nebulized budesonide in asthmatic children.

  2005cited by this paper
• Nongenomic actions of glucocorticosteroids on the airway vasculature in asthma.

  2004cited by this paper
• Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma.

  2004cited by this paper
• Nongenomic actions of steroid hormones

  2003cited by this paper
• Continuous versus intermittent beta‐agonists for acute asthma

  2003cited by this paper
• The interplay between the glucocorticoid receptor and nuclear factor-kappaB or activator protein-1: molecular mechanisms for gene repression.

  2003cited by this paper
• Comparative bronchial vasoconstrictive efficacy of inhaled glucocorticosteroids

  2003cited by this paper
• Update on glucocorticoid action and resistance.

  2003cited by this paper
• Continuous vs intermittent beta-agonists in the treatment of acute adult asthma: a systematic review with meta-analysis.

  2002cited by this paper
• Mechanisms involved in the side effects of glucocorticoids.

  2002cited by this paper
• Comparison of high-dose inhaled flunisolide to systemic corticosteroids in severe adult asthma.

  2002cited by this paper
• Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey

  2002cited by this paper
• The Effectiveness of IV β-Agonists in Treating Patients with Acute Asthma in the Emergency Department: A Meta-analysis

  2002cited by this paper
• Relationship of viral infections to wheezing illnesses and asthma

  2002cited by this paper
• Rapid glucocorticoid effects on immune cells.

  2002cited by this paper
• Different glucocorticoids vary in their genomic and non‐genomic mechanism of action in A549 cells

  2002cited by this paper
• Prospective, placebo-controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma.

  2002cited by this paper
• A prospective multicenter study of patient factors associated with hospital admission from the emergency department among children with acute asthma.

  2002cited by this paper
• Pathogenesis of asthma.

  2002cited by this paper
• Pharmacogenetics of asthma.

  2002cited by this paper
• Early emergency department treatment of acute asthma with systemic corticosteroids.

  2001cited by this paper
• Corticosteroids for acute severe asthma in hospitalised patients.

  2001cited by this paper
• Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study.

  2001cited by this paper
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  2000cited by this paper
• Risk factors associated with glucocorticoid-induced adverse effects in children with severe asthma.

  2000cited by this paper
• A Comparison of Inhaled Fluticasone and Oral Prednisone for Children with Severe Acute Asthma

  2000cited by this paper
• EFFECT OF LONG-TERM TREATMENT WITH INHALED BUDESONIDE ON ADULT HEIGHT IN CHILDREN WITH ASTHMA

  2000cited by this paper
• Corticosteroid therapy in acute asthma.

  2000cited by this paper
• Low-dose inhaled corticosteroids and the prevention of death from asthma.

  2000cited by this paper
• Duration of systemic corticosteroids in the treatment of asthma exacerbation; a randomized study.

  2000cited by this paper
• Long-term effects of budesonide or nedocromil in children with asthma.

  2000cited by this paper
• Transient effect of inhaled fluticasone on airway mucosal blood flow in subjects with and without asthma.

  2000cited by this paper
• Inhaled steroids in acute asthma following emergency department discharge.

  2000cited by this paper
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  2000cited by this paper
• Randomized trial of inhaled flunisolide versus placebo among asthmatic patients discharged from the emergency department.

  2000cited by this paper
• Oral versus intravenous corticosteroids in children hospitalized with asthma.

  1999cited by this paper
• Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: a randomized controlled trial.

  1999cited by this paper
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  1999cited by this paper
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• Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma

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  1999cited by this paper
• Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation.

  1999cited by this paper
• Airway mucosal blood flow in bronchial asthma.

  1998cited by this paper
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  1998cited by this paper
• Effect of nebulized ipratropium on the hospitalization rates of children with asthma.

  1998cited by this paper
• The effects of combined intravenous and inhaled steroids (beclomethasone dipropionate) for the emergency treatment of acute asthma. The Asthma ED Study Group.

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  1995cited by this paper
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  1995cited by this paper
• Early administration of hydrocortisone in the emergency room treatment of acute asthma: a controlled clinical trial.

  1994cited by this paper
• Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma.

  1993cited by this paper
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