Page 29 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 29
maintenance dose of 25mg daily.23 Sidney treated with re-initiation of treatment. The 29
and Alex Friedlaender described a series of 12 medical community had not yet linked asth-
patients who received an average daily dose ma with inflammation of the airways, so the the story of corticosteroids in asthma
of 150 to 200mg oral cortisone which pro- author discusses a probable mechanism of
duced a comparable effect to that obtained cortisone action as follows: “The direct appli-
with intramuscular administration. Interest- cation of cortisone to the bronchial mucosa
ingly they mentioned reduction in eosinophil may either interfere with the union of anti-
counts.24 Savidge R. and Brockcbank studied gen and antibody or inhibit the liberation of
24 asthmatics with remarkable limitation in histamine in the site of shock organ (lung)”.35
their daily activities in 1954: Using a partial- Inhaled dexamethasone in a study of 64 pa-
ly blinded methodology, they started with an tients resulted in withdrawal of oral steroids
initial dose of 100mg cortisone daily or place- in 29 of these patients for a period from 2 to
bo, gradually tapering by 12.5mg every four 120 months.36 In the early 60s, the first stud-
to six weeks in an effort to avoid side effects. ies evaluating the effects of inhaled steroids
In all patients, there was remarkable improve- in lung function with the use of spirometry
ment in symptoms and patient could return to were published.36 Unfortunately, despite these
their daily activities.25 Αt that period, oral cor- advances, the systemic absorption of agents
tisone for asthma treatment was administered such as dexamethasone, even when admin-
as long-term or intermittent basis with an ef- istered by inhalation proved an insuperable
fort to use the minimal needed doses.26 problem.37
The following years, several forms of The Break-through of ICS in Asthma
steroids such as hydrocortisone, prednis- Treatment
olone, triamcinolone and dexamethasone
were used, providing an effective manage- A milestone in asthma treatment was the in-
ment for a disease that previous to their use, vention of Beclomethasone dipropionate
had been life threatening and had detrimen- (BDP) which was patented in 1962 and was
tal effect on patients’ lives.27,28 Unfortunately, the first inhaled corticosteroid (ICS) marketed
oral steroids also have side effects. So, in asth- for use in the treatment of chronic asthma.38
ma steroids have always been a double-edged In 1972 Brown H.M, Storey G. and George
sword, due to their systemic adverse reac- W.H.S published the results of a study in-
tions.29 By 1960 all the systemic toxic effects volving 60 asthmatic patients who received
of oral and parenteral treatment of corticoids Beclomethasone dipropionate by means of a
had been described and OCS-sparing ef- metered aerosol delivering 50 μg of micron-
forts were made in nearly every disease where ized powder per puff.39 (37 of these patients
OCS were used, not only due to safety issues had been oral steroid dependent for up to 16
but also to improve outcomes.27,30–34 This ef- years). Two puffs four times daily, giving a to-
fort was reflected in many published works tal of 400 μg, was the usual dose, occasional-
on the administration of cortisone by inhala- ly increased to three puffs four times a day.
tion which started shortly after intramuscu- In 56 cases 400 μg was the optimum dose but
lar treatment was made an established choice four remained well controlled on 150 to 200
for severe asthma. In 1951, Maxwell Gelfand μg daily. In 28 out of 37 steroid-depended
reported 5 cases of bronchial asthma treat- cases there was complete withdrawal of OCS.
ed for two weeks with 5mg nebulized corti- Besides, 19 out of 23 other asthmatics not de-
sone inhaled every hour for a period of ten pendent on steroids were also completely con-
hours daily. Discontinuation of treatment led trolled. In that study Beclomethasone was the
to relapses, which though, were successfully first inhaled steroid that had no b iochemical
and Alex Friedlaender described a series of 12 medical community had not yet linked asth-
patients who received an average daily dose ma with inflammation of the airways, so the the story of corticosteroids in asthma
of 150 to 200mg oral cortisone which pro- author discusses a probable mechanism of
duced a comparable effect to that obtained cortisone action as follows: “The direct appli-
with intramuscular administration. Interest- cation of cortisone to the bronchial mucosa
ingly they mentioned reduction in eosinophil may either interfere with the union of anti-
counts.24 Savidge R. and Brockcbank studied gen and antibody or inhibit the liberation of
24 asthmatics with remarkable limitation in histamine in the site of shock organ (lung)”.35
their daily activities in 1954: Using a partial- Inhaled dexamethasone in a study of 64 pa-
ly blinded methodology, they started with an tients resulted in withdrawal of oral steroids
initial dose of 100mg cortisone daily or place- in 29 of these patients for a period from 2 to
bo, gradually tapering by 12.5mg every four 120 months.36 In the early 60s, the first stud-
to six weeks in an effort to avoid side effects. ies evaluating the effects of inhaled steroids
In all patients, there was remarkable improve- in lung function with the use of spirometry
ment in symptoms and patient could return to were published.36 Unfortunately, despite these
their daily activities.25 Αt that period, oral cor- advances, the systemic absorption of agents
tisone for asthma treatment was administered such as dexamethasone, even when admin-
as long-term or intermittent basis with an ef- istered by inhalation proved an insuperable
fort to use the minimal needed doses.26 problem.37
The following years, several forms of The Break-through of ICS in Asthma
steroids such as hydrocortisone, prednis- Treatment
olone, triamcinolone and dexamethasone
were used, providing an effective manage- A milestone in asthma treatment was the in-
ment for a disease that previous to their use, vention of Beclomethasone dipropionate
had been life threatening and had detrimen- (BDP) which was patented in 1962 and was
tal effect on patients’ lives.27,28 Unfortunately, the first inhaled corticosteroid (ICS) marketed
oral steroids also have side effects. So, in asth- for use in the treatment of chronic asthma.38
ma steroids have always been a double-edged In 1972 Brown H.M, Storey G. and George
sword, due to their systemic adverse reac- W.H.S published the results of a study in-
tions.29 By 1960 all the systemic toxic effects volving 60 asthmatic patients who received
of oral and parenteral treatment of corticoids Beclomethasone dipropionate by means of a
had been described and OCS-sparing ef- metered aerosol delivering 50 μg of micron-
forts were made in nearly every disease where ized powder per puff.39 (37 of these patients
OCS were used, not only due to safety issues had been oral steroid dependent for up to 16
but also to improve outcomes.27,30–34 This ef- years). Two puffs four times daily, giving a to-
fort was reflected in many published works tal of 400 μg, was the usual dose, occasional-
on the administration of cortisone by inhala- ly increased to three puffs four times a day.
tion which started shortly after intramuscu- In 56 cases 400 μg was the optimum dose but
lar treatment was made an established choice four remained well controlled on 150 to 200
for severe asthma. In 1951, Maxwell Gelfand μg daily. In 28 out of 37 steroid-depended
reported 5 cases of bronchial asthma treat- cases there was complete withdrawal of OCS.
ed for two weeks with 5mg nebulized corti- Besides, 19 out of 23 other asthmatics not de-
sone inhaled every hour for a period of ten pendent on steroids were also completely con-
hours daily. Discontinuation of treatment led trolled. In that study Beclomethasone was the
to relapses, which though, were successfully first inhaled steroid that had no b iochemical
