ABUSE OF THERAPY WITH CORTICOSTEROIDS IN THE ASTHMATIC PATIENT AND THE DEFICIENT CONTROL OF SUPRARENAL FUNCTION - INDICATION OF THERAPY WITH ACTH

The use of corticosteroids, either oral, parenteral or as aerosol, mea ns a great step forward in bronchial asthma treatment Nevertheless, gi ven the abuse of their administration, we find more and more frequentl y, cases of corticodependent bronchial asthma, due to a deficient cont rol in the clinical evolution. For this reason, we performed a study w ith 39 patients diagnosed with corticodependent intrinsic bronchial as thma. Basal cortisol determination was performed in all, and all of th em followed posttreatment with ACTH, antibiotics and mucolytics, as we ll as follow up of respiratory function parameters and clinical evolut ion. We found a mean increase in cortisol levels of 488% (basal: 2.49 +/- 0.33 mu g/dl; posttreatment: 14.59 +/- 2.9 mu g/dl). Regarding the respiratory function tests, FEV(1) improved from 59.38 +/- 4.23% to 6 8.52% +/- 4.28% (15.4% increase); MEF50 went from 28.62 +/- 3.47% to 3 5.9 +/- 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 m edication improved in general, going from an initial punctuation of 8. 5 to a posttreatment score of 7.47. In general, 50% of the patients st udied improved from the clinical point of view, only 47.2% had a discr ete improvement, and only one patient got worse. Side effects with ACT H treatment appeared in 28.2% of the cases, mainly peripheral edemas, especially in the lower extremities. In conclusion, with patients unde rgoing lengthy corticosteroid therapy, control of their suprarenal fun ction is absolutely necessary. If a glandular insufficiency appears wi th low levels of plasmatic cortisol, we advise treatment with ACTH in association with antibiotics.