Corticosteroids for acute asthma

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  • Citation tools Download this article to citation manager Iacobucci Gareth . Consider corticosteroids for acute sore throat, says BMJ review BMJ 2017; 358 :j4333
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    Inhaled short-acting beta 2 agonist treatment is the mainstay of office or emergency department treatment of moderate to severe asthma exacerbations. If the patient can tolerate a measurement of PEF or forced expiratory volume in one second (FEV 1 ), an initial value should be obtained and repeated to monitor treatment response. In patients with severe exacerbations, continuous beta 2 agonist administration has been shown to improve pulmonary function measurements and reduce hospital admission with no notable differences in pulse, blood pressure, or tremor. 21 The use of high-dose albuterol ( mg via nebulizer every 20 minutes for three doses) 22 and intravenous beta 2 agonists does not appear to be beneficial and is not recommended. 23

    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.

    Corticosteroids for acute asthma

    corticosteroids for acute asthma

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