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Steroid Dependent Asthma Treatment

Steroid-depended asthma is a type of asthma whereby there is a need for daily administration of oral corticosteroids to manage asthmatic attacks and flareups. Steroid dependency in general refers to individuals with frequently relapsing nephrotic syndrome (FRNS) in whom two consecutive relapses, or two of four relapses in any 6-month period, occur while still on the prescribed dose.

Asthma is a chronic disease affecting the lungs whereby the lungs get inflamed, which results in narrowing making it hard to breath. However, use of steroids is the main treatment for the condition since they both help to control asthma and prevent asthma attacks or flareups. Steroids work by reducing inflammation, swelling, and mucus production in the airways of an asthma patient.

The significance of inhaled steroids for asthma can lead to:

  • Fewer symptoms and flare-ups
  • Better asthma control
  • Reduced need for hospitalization

Common Causes of Asthma

Some of the common causes of asthma include:

  • Dust mites
  • Cockroach feces
  • Mold spores and fragments
  • Pollen from trees, grass, and weeds
  • Air pollution
  • Strong chemical odors or perfumes
  • Dusty rooms
  • Cold air
  • Gastroesophageal reflux disease (GERD)
  • Infections like sinusitis

Signs and Symptoms of Asthma

  • Persistent bronchial obstruction if steroids are not administered (in steroid dependent asthma)
  • Shortness of breath that may limit activity
  • Chest tightness or pain
  • Wheezing when exhaling
  • Trouble sleeping caused by shortness of breath, coughing or wheezing
  • Coughing or wheezing attacks that are worsened by a respiratory virus

Diagnosis Common Causes for Steroid-dependent Asthma

In the diagnosis of steroid-dependent asthma, the pulmonologist or asthma specialist may conduct a number of tests just to make sure that it’s asthma that is causing the symptoms in the patient and not other medical conditions. The tests carried out include the following:

  • Bronchoprovocation test: Here the doctor measures the amount of nitric oxide in the patient when he/she exhales. This can be used in a more mild asthma where the patient might not feel extreme symptoms.
  • Exhaled nitric oxide test: The patient is asked to breathe into a tube connected to a machine that measures the amount of nitric oxide in his/her breath. The indication here is that the levels of the gas could be high if an individual’s airways are inflamed.
  • Methacholine challenge: During this test, the patient inhales a chemical by the name of methacholine before and after spirometry. This is meant to see if the patient’s airways narrow. If the result falls at least 20%, chances are high that the patient might have asthma.

Other tests could include

  • Sputum eosinophils: It is a test for high levels of white blood cells in saliva and mucus that comes out when an individual coughs.
  • CT-scan: A series of X-rays are conducted to make a view of the patient’s insides. A scan of the patient’s lungs and sinuses can identify physical problems or diseases that cause breathing problems.
  • Chest X-rays: This isn’t really an asthma test, but a health care provider may use it to rule out or rather make sure nothing else is causing symptoms in the patient.

Treatment of Asthma

There are a number of asthma treatments which can ease the patient’s symptoms. The specialist works closely with the patient to make an asthma action plan that outlines treatment and medication. The plan might include:

  • Inhaled corticosteroids: These are used to treat asthma in the long term (steroid dependent asthma). The patient takes them on a daily basis so as to keep his/her asthma under control. Inhaled corticosteroids prevent and ease swelling inside the patient’s airways and help the body make less mucus. Common corticosteroids include Beclomethasone (QVAR), Budesonide (Pulmicort), and Fluticasone.
  • Leukotriene modifiers: This is a long-term asthma treatment. The medication blocks leukotrienes i.e. things in an individual’s body that trigger an asthma attack. They are taken as pills once a day. Examples of leukotriene modifiers include: Montelukast (Singular) and Zafirlukast (Accolate).
  • Long-acting-agonists: These primarily relax the muscle band that surrounds an individual’s airways. An individual takes the medication with an inhaler, even when he/she has no symptoms. Examples include: Ciclesonide (Alvesco), Formoterol (Perforomist), Mometasone (Asmanex), and Salmeterol (Serevant).
  • Theophylline: This medication opens the patient’s airways and eases tightness in his/her chest. This is a long-term medication that can either be taken by itself or with an inhaled corticosteroid.
  • Short-acting beta-agonists: Also known as rescue inhalers, short-acting-agonists loosen the bands of muscles around the patient’s airways and ease his/her symptoms. Examples include: Albuterol (Accuneb, ProAir FHA, Ventolin FHA), and Levalbuterol (Xopenex HFA).
  • Anticholinergics: These are known to prevent the muscle bands around the patient’s airways from tightening. The common ones include: Ipratropium (Atrovent FHA), and Tiotropium bromide (Spiriva).
  • Biologics: This is primarily for patients with a severe asthma attack that does not respond to control medications. Examples of biologics include:
  1. Omalizumab (Fasenra) which treats asthma caused by allergens. It’s administered as an injection every 2 to 4 weeks
  2. Biologics that are meant to stop a patient’s immune cells from creating factors that lead to inflammation. These include:
    1. Mepolizumab (Nucala)
    2. Benralizumab (Fasenra)
    3. Benrazumab (Cinqair)