TROLEANDOMYCIN IN THE TREATMENT OF DIFFICULT ASTHMA

Background: For difficult asthma, treatment is aimed at improving airw ay obstruction and minimizing adverse effects of systemic corticostero ids. The combination of troleandomycin (TAO) with methylprednisolone ( MP) reportedly has a beneficial steroid-sparing effect on difficult as thma. Methods: To test the steroid-sparing effect of TAO, 14 subjects with severe corticosteroid-dependent asthma were studied before and du ring treatment with MP and TAO Results: Treatment with MP and TAO resu lted in a clear reduction in respiratory symptoms, asthmatic attacks, corticosteroid and hospitalization requirements, improvement in pulmon ary function tests, and a remarkable decrease in peak expiratory flow rate circadian variability when compared with the period before TAO tr eatment (with corticosteroids). Treatment with MP and TAO was fairly w ell tolerated. Only a reduction (-5.2%, p < 0.01) in bone mineral cont ent and an increase in plasma glucose levels (from 81. 7 to 94.3 mg/dl , p < 0.05) were found, in comparison with pre-TAO values. One subject discontinued MP-TAO treatment because of a mild but persistent increa se in serum alanine aminotransferase. In an evaluation of the clinical and pulmonary function test results, eight of the 14 subjects were re sponders and six were nonresponders. During follow-up three subjects d iscontinued TAO and consequently had an asthmatic attack after 4, 7, o r 15 days, respectively. Conclusions: This study confirms that treatme nt with MP and TAO has a beneficial effect in a subgroups of severely steroid-dependent asthma patients.