High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma

Article Abstract:

Asthma is quite common, but for the majority of patients the symptoms are mild and easily controlled. Agents such as beta-2 agonists, cromolyn, and inhaled corticosteroids, or a combination of these, are effective in controlling asthmatic symptoms in most cases. A small minority of patients suffer severe symptoms and do not achieve effective relief from these treatments, however; in some cases the asthma is life-threatening. These patients generally are chronically dependent on steroids, have frequent emergency room visits and hospitalizations, and have often required mechanical ventilation. Since a previous pilot study had indicated that triamcinolone may be effective in the treatment of patients with severe asthma, a controlled cross-over study involving 12 patients was designed to establish if high-dose intramuscular injections of triamcinolone are indeed superior to low-dose prednisone treatment. The patients in the triamcinolone group were given high-dose intramuscular injections for the first three days of a three-month trial period. Patients in the control group received low-dose prednisone over the entire three-month period. A total of 21 emergency room visits and 10 hospitalizations were required by patients in the prednisone cycle of the trial, while none were required during the triamcinolone portions of the trial. Four patients felt well enough to discontinue all other asthma medication during their high-dose triamcinolone treatment. Measurements of respiratory function revealed superior performance among the patients taking triamcinolone. However, the side effects of steroid treatment were also more severe in this group. These side effects include Cushingoid faces, acne, increased facial hair, muscle aches, and disturbances of taste. The results demonstrate that high-dose triamcinolone is more effective than low-dose prednisone in the treatment of severe asthma, but somewhat worse side effects may be expected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Antiasthmatic agents, Triamcinolone

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Aerosol steroids as primary treatment of mild asthma

Article Abstract:

Asthma is now thought to be an inflammatory disease of the airways, with far-reaching implications for treatment. If this is true, treatment of even mild cases of asthma should stress prevention and control of the disease, similar to the management of other chronic diseases, such as diabetes. Elimination of the causes of the allergies (allergens) in the environment, insofar as possible, is the first step, and should be followed by immunotherapy (desensitization to allergens), if needed, for those allergens that cannot be avoided. Patients with chronic inflammation will need regular medication with one or more of the five classes of drugs now used for treatment of asthma. These drug classes are: anticholinergics (to reduce spasms of the smooth muscles in the airways), beta-adrenergic agonists (which block impulses to the sympathetic nervous system), theophylline (bronchodilators), and the anti-inflammatory agents cromolyn and glucocorticoids. The drugs and their dosages must be adjusted to the individual patient, and modified as the severity of the disease warrants. It is usually recommended that patients with daily asthma be treated with both an anti-inflammatory drug and a bronchodilator. Tari Haahtela and colleagues report in the August 8, 1991 issue of The New England Journal of Medicine that patients with newly-diagnosed mild asthma did better when treated with inhaled budesonide (a steroid) than with terbutaline (a beta-2-agonist). Problems with the use of budesonide are discussed. Asthma is still not fully understood, and so far there is no cure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Budesonide, editorial

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Mild asthma

Article Abstract:

The treatment of mild asthma is reviewed, focusing on beta agonists, corticosteroids, nedocromil, cromolyn sodium, and drugs that modify the leukotriene pathway. Mild asthma is defined as symptoms less than once a day, few night awakenings, and an FEV(sub 1) of at least 80%.

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