TREATMENT OF STEROID-RESISTANT ASTHMA

Asthma that requires chronic glucocorticoid therapy for control or tha t does not improve with glucocorticoid therapy is a clinical challenge . The mechanisms responsible for glucocorticoid-dependent or glucocort icoid-resistant asthma are varied. No single therapy is universally he lpful in controlling asthma and permitting a reduction of glucocortico id side effects. Double-blind, placebo-controlled trials of weekly, pu lse methotrexate, gold salts, and cyclosporine are available in the me dical literature to support the use of these agents. Additional inform ation suggests the value of other therapies, including troleandomycin, hydroxychloroquine, dapsone, nonsteroidal anti-inflammatory drugs, in travenous immunoglobulin, and heparin. This author believes that oral gold therapy with auranofin is the least toxic therapy with data suppo rting efficiency in glucocorticoid-dependent or glucocorticoid-resista nt asthma.