Systemic corticosteroids for copd

While the genetics of SLE are not very well understood, there is growing evidence for the involvement of specific genes in this complex autoimmune disease . Part of the complexity of this disease is due to the effects of both environment and genetics factors that may contribute to its development. [49] Further compounding our understanding of the etiology of the disease is the involvement of several organ systems. [50] Genetic studies of the rates of disease in families supports the genetic basis of this disease with a heritability of >66%. [51] Identical ( monozygotic ) twins were found to share susceptibility to the disease at >35% rate compared to fraternal ( dizygotic ) twins and other full siblings who only showed a 2–5% concordance in shared inheritance. [51]

Greenspun, Bertram. "Systemic Lupus Erythematosus." eMedicine . Eds. Martin K. Childers, et al. 23 Apr. 2009. Medscape. 21 Jul. 2009 <http:///article/305578-overview>. Hahn, Bevrah, and Betty P. Tsao. "Systemic Lupus Erythematosus and Related Syndromes." Kelley's Textbook of Rheumatology. Eds. Edward Harris, et al. 7th ed. Philadelphia: . Saunders, 2005. MD Consult . Elsevier, Inc. 21 Jul. 2009 <http://>. Sjowali, Christopher, et al. "Serum Levels of Autoantibodies Against Monomeric C-Reactive Protein Are Correlated with Disease Activity in Systemic Lupus Erythematosus." Arthritis Research & Therapy 6 2 (2004): 87-94. Medscape Today . Medscape. 21 Jul. 2009 <http:///viewarticle/466990>. Source: Medical Disability Advisor

Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile . [43] The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception . [44] In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone. [45] The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field. [46] The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.

There is high-quality evidence to support treatment of exacerbations of COPD with systemic corticosteroid by the oral or parenteral route in reducing the likelihood of treatment failure and relapse by one month, shortening length of stay in hospital inpatients not requiring assisted ventilation in ICU and giving earlier improvement in lung function and symptoms. There is no evidence of benefit for parenteral treatment compared with oral treatment with corticosteroid on treatment failure, relapse or mortality. There is an increase in adverse drug effects with corticosteroid treatment, which is greater with parenteral administration compared with oral treatment.

Asthma is a complex disease of the respiratory tract associated with chronic inflammation in which an intricate network of cells and cellular factors plays a major role. Asthma is one of the most common chronic diseases, with an estimated 300 million cases worldwide, imposing a considerable burden on society in morbidity, quality of life, and healthcare costs. Inhaled corticosteroids (ICSs) form the gold standard, first-line therapy in the effective management of persistent asthma and reduce morbidity and mortality from asthma. However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitary-adrenal-axis suppression, measured by serum or urine cortisol decrease, correlates with the occurrence of systemic side effects of high-dose ICSs. Therefore, cortisol may be a relevant surrogate marker to identify the potential for adverse effects from ICS therapy. Ciclesonide is a new generation ICS with demonstrable safety and efficacy in the treatment of asthma. The unique pharmacologic characteristics of ciclesonide, such as reduced local adverse effects, lack of cortisol suppression, and the option for once-daily dosing, may improve compliance with therapy and allow long-term use of ICSs without fear of systemic adverse effects.

Systemic corticosteroids for copd

systemic corticosteroids for copd

There is high-quality evidence to support treatment of exacerbations of COPD with systemic corticosteroid by the oral or parenteral route in reducing the likelihood of treatment failure and relapse by one month, shortening length of stay in hospital inpatients not requiring assisted ventilation in ICU and giving earlier improvement in lung function and symptoms. There is no evidence of benefit for parenteral treatment compared with oral treatment with corticosteroid on treatment failure, relapse or mortality. There is an increase in adverse drug effects with corticosteroid treatment, which is greater with parenteral administration compared with oral treatment.

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