Justines Asthma pages

I came back from hospital today in total dismay. I can not beleive the Doctor wants me to try steroids again when they DO NOT work, just to show him, as obviously he does not beleve me or my 34yr medical records. AAGGHH! I am sitting here in tears writing this. My own GP even says I am steroid resistant. I give up sometimes. They have run out of things to give you so they start again with the good old steroids. Well no way. Whats the point. They do not help me any more and I certainly do not want all there dam side affects for nothing. I wonder if other severe asthmatics get as frustrated as I do sometimes. I have been on and off them all my life. I was in hospital for eight months as they could not get the asthma under control (with steroid injections) and last winter I had some sort of reaction to them. I went to the Doctor breathless and covered in red rash and itching and swollen. She took me off them. Was this a allergic reaction. I vowed from then on not to take them. They do not work for me. I feel I am going mad or something. The Doctor said I will take a fatal attack as he has me up top medication if I do not try the steroids again Why? Why? I can not beleive all this.

Treatment with oral steroids is the most potent therapy available for acute, chronic and especially severe asthma. Unfortunately, a small fraction are steroid resistant and do not benefit from standard treatment. (yip). It is important to identify these patients as early as possible. Patients who do not respond to low steroid doses are often placed on high doses, which in steroid resistant asthmatics can have effects without providing any benefit. In addiction treatment for these patients is a challenging medical problem. A rough estimate says it happens in about 15-20% of asthmatics. Steroid resistance was first discribed in 1968. Resistance to inhaled steroids is not well studied (I think it should be) and the fraction of these patients who fall into this category may be even higher. Patients with steroid resistants seen to have the severe disease. Once a gp realizes that a patient has steroid resistant asthma they should be referred to a specialist. The first step is to see if the patient really does have asthma and not something else. If asthma is confirmed then ruling out allergies and the bodies clearance of steroids is ok.

There are two types of steroid resistant asthma. The vast majority 90% are type I which is a reversible, decreased binding affinity of T cells for glucocorticoids. The remaining patients are type II in which theses patients carry a very low glucocorticoid binding sites. Because there is only one human glucocorticoid receptor gene, type I patients can develope severe side effects from steroid treatments suggesting type I to be an aquired disorder. Type two has the hallmarks of an irreversible, (primary) defect. It raises the possibilty that steroid resistant asthma is the end result of immune activation that is no longer controlled by steroids. Clinic aspects for future investigation will be the specific cells involved in asthma. 

Once a patient is dignosed withsteroid dependent asthma is to find out if it's type I or II. This is followed by patient education and indroduction of immunomodulatory therapies. As of now there is no alternatives to steroid treatments. There has been some success with intravenous gamma globulin. This treatment can lead to normal T cell sensitivity to corticosteroids. There has also been another reported sucess with cyclosporine. Other potential treatment include methotrexate, gold, hydroxychloroquine, dapsone and interferon-y. The prognosis of people with severe asthma is poor. The best approach to the disease is to manage it early, before the patients airways become irreversible.

Asthma patients who do not respond very well to steroids suffer repeated asthma attacks (yip) very often. They are at a greater risk of dying from their condition. Reasearchers have found that vitamin D3 could improve their responsiveness to steroid treatment. Asthma is usually controlled with steroids but some people with severe asthma do not respond to them limiting their treatment options. They found that when vitamin D3 was taken with dexamethasone this defect was reversed and the resistant steroid cells were able to respond to treatment. At the moment it is experimental and clinic trials have to be done. Hopefully this will open a new avenue.