Abuse of therapy with corticosteroids in the asthmatic patient and the deficient control of suprarenal function. Indication of therapy with ACTH

Abstract

The use of corticosteroids, either oral, parenteral or as aerosol, means a great step forward in bronchial asthma treatment. Nevertheless, given the abuse of their administration, we find more and more frequently, cases of corticodependent bronchial asthma, due to a deficient control in the clinical evolution. For this reason, we performed a study with 39 patients diagnosed with corticodependent intrinsic bronchial asthma. Basal cortisol determination was performed in all, and all of them followed posttreatment with ACTH, antibiotics and mucolytics, as well as follow up of respiratory function parameters and clinical evolution. We found a mean increase in cortisol levels of 488% (basal: 2.49 +/- 0.33 micrograms/dl; posttreatment: 14.59 +/- 2.9 micrograms/dl). Regarding the respiratory function tests, FEV1 improved from 59.38 +/- 4.23% to 68.52% +/- 4.28% (15.4% increase); MEF50 went from 28.62 +/- 3.47% to 35.9 +/- 3.81% (25.4% increase) and MEF25-75 improved from 28.89 +/- 3.47% to 37.05 +/- 3.93% (28.2% increase). Clinical symptomatology and medication improved in general, going from an initial punctuation of 8.5 to a posttreatment score of 7.47. In general, 50% of the patients studied improved from the clinical point of view, only 47.2% had a discrete improvement, and only one patient got worse. Side effects with ACTH treatment appeared in 28.2% of the cases, mainly peripheral edemas, especially in the lower extremities. In conclusion, with patients undergoing lengthy corticosteroid therapy, control of their suprarenal function is absolutely necessary. If a glandular insufficiency appears with low levels of plasmatic cortisol, we advise treatment with ACTH in association with antibiotics.