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  Authority of Polish Society of Allergology

vol 3. no 3. September 1998  

 Bronchial asthma
Corticosteroid resistant chronic asthma - pathomechanism, diagnosis and treatment
Krzysztof Wytrychowski, Janusz Patkowski

Katedra i Klinika Chorób Wewnętrznych i Alergologii Akademii Medycznej, ul. Traugutta 57/59, 50-417 Wrocław

Corticosteroid resistant (CR) chronic asthma is a rare and specific phenomenon, which brings therapeutic and diagnostic problems. It's pathogenesis is complicated and not fully defined. In the first reports CR asthma was characterised with the glucocorticosteroids (GCS) failure to inhibit the activity of inflammatory cells (T-lymphocytes, monocytes, neutrophiles) involved in the late asthmatic reaction. In other studies a functional and quantitative defects of glucocorticosteroid receptor were observed. In a recent study it has been suggested that CR is connected with an increased intracellular concentration of two transcription factors: activator proteine 1 and nuclear factor kB. Secondary CR seems to be more frequent phonomenon caused by, for example, chronic overdosage of short-acting ?2-agonists. Oral prednisolone test is normally performed in clinical diagnostics of primary CR asthma. Vasoconstriction assay according to Stoughton and McKenzie may be used as an additionall method. Treatment of CR asthma is based on inhaled GCS in high doses, oral GCS in optimally established doses and long-acting ?2-agonists. In some cases alternative treatment, macrolids or immunosupressants, are administered. Recently developed leukotriene receptor antagonists or inhibitors of leukotrienes synthesis can be applied as a supplementary treatment of CR asthma.


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