Steroid-resistant asthma

Topical steroids such as Lotemax (loteprednol etabonate, Bausch + Lomb) can be used to treat the inflammation associated with more severe GPC. However, long-term use of topical steroids can have potential side effects such as elevated intraocular pressure, glaucoma and cataracts. Antihistamine/mast cell stabilizers may also be used; however, these are of limited usefulness, as GPC is not primarily a mast cell-mediated response like seasonal allergic conjunctivitis. First and foremost, however, it is important to discontinue contact lens wear until GPC improves. 20 If it is not possible to discontinue lens wear altogether, for example in instances such as keratoconus, lens wearing time should be reduced as much as possible until GPC improves.

Eleanor Lederer, MD, FASN  Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science , American Federation for Medical Research , American Society for Biochemistry and Molecular Biology , American Society for Bone and Mineral Research , American Society of Nephrology , American Society of Transplantation , International Society of Nephrology , Kentucky Medical Association , National Kidney Foundation , Phi Beta Kappa

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology<br/>Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc<br/>Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

Varricchi and colleagues (2016) noted that although eosinophils represent approximately 1 % of peripheral blood leukocytes, they have the propensity to leave the blood stream and migrate into inflamed tissues.  Eosinophils and their mediators are critical effectors to asthma and eosinophilic granulomatosis with polyangiitis (EGPA).  Eosinophils are equipped with a large number of cell-surface receptors and produce specific cytokines and chemokines.  Eosinophils are the major source of iIL-5 and highly express the IL-5Rα on their surface.  Clinical trials evaluating monoclonal antibodies (MAbs) to IL-5 (mepolizumab and reslizumab) and its receptor IL-5Rα (benralizumab) have been or are underway in patients with eosinophilic asthma, EGPA and chronic obstructive pulmonary disease (COPD).  Overall, targeting IL-5/IL-5Rα is associated with a marked decrease in blood and sputum eosinophilia, the number of exacerbations and improvement of some clinical parameters in adult patients with severe eosinophilic asthma.  Preliminary findings from pilot studies suggested that mepolizumab might be a glucocorticoid-sparing treatment in patients with EGPA.  A preliminary study found that benralizumab did not reduce the exacerbations and did modify lung function in patients with eosinophilic COPD.  The authors concluded that this review examined recent advances in the biology of eosinophils and how targeting the iIL-5 pathway might offer benefit to some patients with severe asthma, EGPA, and COPD.  They stated that IL-5/IL-5Rα-targeted treatments offer promises to patients with eosinophilic respiratory disorders.  These researchers noted that ongoing studies will provide information whether IL-5/IL-5Rα inhibition is safe and effective in children with eosinophilic asthma and selected patients with EGPA or COPD.

I have severe asthma. I am 49 years old. I had a sinus surgery in 2004 and woke up wheezy – never had asthma before this! Eosinophils in my lungs for no reason. I have been on prednisone since 2004. Not real high doses, but many bursts that start at 100mg. My baseline for the last year has been 10mg a day. However, I started receiving Nucalla injections last fall and started a taper of my pred dosage not long after. As of June 2017, I am steroid free! Amen! However, I am feeling some serious side affects. I have extreme fatigue and joint pain. I felt fortunate that pred has not damaged me in some way for so long – until now. I am an avid runner and kept my weight down. When I couldn’t breath, I couldn’t run. So I would up the dose so I could keep fit. No bone damage or high blood sugar or high blood pressure. I credit this to maintaining a grueling workout schedule. After reading other posts, etc… I feel fortunate (knock on wood)……… I am working thru my adrenal gland issues with docs and I pray that I will recover soon from that as well. Thank you for your posts and let me know if I can help answer any questions of pred use. I have literally taken thousands of milligrams over the years…….

Steroid-resistant asthma

steroid-resistant asthma

I have severe asthma. I am 49 years old. I had a sinus surgery in 2004 and woke up wheezy – never had asthma before this! Eosinophils in my lungs for no reason. I have been on prednisone since 2004. Not real high doses, but many bursts that start at 100mg. My baseline for the last year has been 10mg a day. However, I started receiving Nucalla injections last fall and started a taper of my pred dosage not long after. As of June 2017, I am steroid free! Amen! However, I am feeling some serious side affects. I have extreme fatigue and joint pain. I felt fortunate that pred has not damaged me in some way for so long – until now. I am an avid runner and kept my weight down. When I couldn’t breath, I couldn’t run. So I would up the dose so I could keep fit. No bone damage or high blood sugar or high blood pressure. I credit this to maintaining a grueling workout schedule. After reading other posts, etc… I feel fortunate (knock on wood)……… I am working thru my adrenal gland issues with docs and I pray that I will recover soon from that as well. Thank you for your posts and let me know if I can help answer any questions of pred use. I have literally taken thousands of milligrams over the years…….

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