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.