• 제목/요약/키워드: Corticosteroid therapy

검색결과 154건 처리시간 0.032초

Add-on Therapy for Symptomatic Asthma despite Long-Acting Beta-Agonists/Inhaled Corticosteroid

  • Dreher, Michael;Muller, Tobias
    • Tuberculosis and Respiratory Diseases
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    • 제81권1호
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    • pp.1-5
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    • 2018
  • Asthma, remains symptomatic despite ongoing treatment with high doses of inhaled corticosteroids (ICS) in conjunction with long-acting beta-agonists (LABA), is classified as "severe" asthma. In the course of caring for those patients diagnosed with severe asthma, stepping up from ICS/LABA to more aggressive therapeutic measures would be justified, though several aspects have to be checked in advance (including inhaler technique, adherence to therapy, and possible associated comorbidities). That accomplished, it would be advisable to step up care in accordance with the Global Initiative for Asthma (GINA) recommendations. Possible strategies include the addition of a leukotriene receptor antagonist or tiotropium (to the treatment regimen). The latter has been shown to be effective in the management of several subgroups of asthma. Oral corticosteroids have commonly been used for the treatment of patients with severe asthma in the past; however, the use of oral corticosteroids is commonly associated with corticosteroid-related adverse events and comorbidities. Therefore, according to GINA 2017 these patients should be referred to experts who specialize in the treatment of severe asthma to check further therapeutic options including biologics before starting treatment with oral corticosteroids.

Acute Respiratory Distress Syndrome With Alveolar Hemorrhage due to Strongyloidiasis Hyperinfection in an Older Patient

  • Kim, Eun Jin
    • Annals of Geriatric Medicine and Research
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    • 제22권4호
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    • pp.200-203
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    • 2018
  • Strongyloides stercoralis is an intestinal nematode that occurs sporadically in temperate areas like Korea. People who are in the immunosuppressed state, over the age of 65 or under the corticosteroid therapy are at risk for developing Strongyloides hyperinfection syndrome. Acute respiratory distress syndrome (ARDS) with alveolar hemorrhage is a rare presentation of Strongyloides hyperinfection. A 78-year-old man had been irregularly injected corticosteroid on his knees, but did not have any immunosuppressive disease. He was initially diagnosed with ARDS and septic shock. Bronchoalveolar lavage (BAL) fluid was bloody and its cytology revealed helminthic larvae identified as S. stercoralis. Results of Cytomegalovirus polymerase chain reaction (PCR), Pneumocystis jirovecii PCR, and Aspergillus antigen testing of the BAL fluid were positive. The clinical progress quickly deteriorated with multiple organ failure, shock and arrhythmia, so he finally died. This is a rare case of ARDS in an older patient without any known immunosuppressive conditions, with alveolar hemorrhage and S. stercoralis being found via BAL.

소아 Henoch-$Sch{\ddot{o}}nlein$ purpura에서 스테로이드 치료 기간에 따른 임상적 결과의 비교 (Comparison of Clinical Outcome According to the Duration of Corticosteroid Therapy in Childhood Henoch-$Sch{\ddot{o}}nlein$ Purpura: a Bicentric Study)

  • 이수진;신재일;이종국;김기혁
    • Childhood Kidney Diseases
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    • 제12권2호
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    • pp.170-177
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    • 2008
  • 목 적 : Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) 환아에서 스테로이드 치료 기간에 따른 HSP의 재발이나 신장염 발생 빈도의 차이를 보기 위하여 본 연구를 시행하였다. 방 법: 일산에 위치한 두 종합 병원에 2000년부터 2003년까지 HSP로 진단 받은 186명 (평균 연령 6.3${\pm}$2.5 세, 남:여 = 104:82)의 환아 들에서 후향적 분석을 시행 하였다. 스테로이드 치료기간에 따른 예후의 차이를 보기 위하여 A 병원에서는 복통 및 관절통 증상이 경한 경우에는 경구 프레드니솔론을 투여 하였으며 복통 및 관절통이 심한 경우에는 정맥 내 덱사메타손을 투여 후에 경구 프레드니솔론을 복용하는 방법으로 치료를 시행하였는데 연구 전에 미리 계획한 대로 증상의 기간과 경중에 상관 없이 스테로이드 치료 기간은 최소 2주 이상 유지하였다. (A군, 94명) B 병원에서는 복통 및 관절통이 경한 경우에는 스테로이드제재 복용을 하지 않았으며, 심한 복통 및 관절통을 동반하는 경우 경구 프레드니솔론을 복용 하도록 하였으며 증상이 소실되면 즉시 용량을 감량하여 끊도록 하였다. (B군, 92명) 결 과 : 두 그룹간의 연령, 성별, 체중, 백혈구, 적혈구, 혈색소, 혈소판, 혈장 내 단백질, 알부민 수치는 통계적으로 차이가 없었다. 또한 복통(45%vs. 50%, P=0.557) 혹은 관절통(61% vs. 61%, P=1.0)의 발생 빈도도 두 군간에 차이가 없는 것으로 나타났다. 그러나 스테로이드 치료의 기간은 A군에서 B군 보다 길었으며(21.8${\pm}$8.4 vs. 6.1${\pm}$7.4 days, P<0.0001), 프레드니솔론의 누적 용량 또한 A군에서 높았다(20.2${\pm}$11.2 vs. 4.9${\pm}$5.9 mg, P<0.0001). 신장염의 발생은 A군에서 높게 나타났으며(23% vs. 10%, P=0.017), 반면에 재발률은 B군에서 높게 나타났다(10% vs 23%, P=0.017). 결 론 : 스테로이드의 사용 기간이 HSP 환자군의 신장 침범 발생률에 영향을 주지 못하였다. 그러므로 HSP 환아의 치료에서 스테로이드는 선별적으로 사용하여야 하며, 급성 증상이 조절되고 나면 즉시 용량을 줄여서 복용을 중단하는 것이 좋을 것으로 생각된다.

A Case of Esophageal Candidiasis in an Adolescent Who Had Frequently Received Budesonide Nebulizing Therapy

  • Kang, Hae Ryong;Kwon, Yong Hoon;Kim, Yong Joo
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제16권3호
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    • pp.185-189
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    • 2013
  • Corticosteroid (budesonide) nebulizer therapy is commonly performed. Its side effects have been considered as being safe or ignorable. The authors present a case of esophageal candidiasis in a healthy female adolescent who was treated with budesonide nebulizer therapy a few times for a cough during the previous winter season. This child presented with dysphagia and epigastric pain for 1 month. Esophageal endoscopy showed a whitish creamy pseudomembrane and erosions on the esophageal mucosa. Pathologic findings showed numerous candidal hyphae. She did not show any evidence of immunodeficiency, clinically and historically. The esophageal lesion did not resolve naturally. The esophageal lesion completely improved with the antifungal therapy for 2 weeks; the symptoms disappeared, and the patient returned to normal health. It is important that frequent esophageal exposure to topical corticosteroids application can cause unexpected side effects.

요통 치료를 위한 경막외 스테로이드 주입후 발생한 양측 무혈성 대퇴골두괴사 (Bilateral Avascular Necrosis of the Femoral Head After Epidural Steroid Injection for the Management of Low Back Pain)

  • 김동진;노선주;반종석;민병우
    • The Korean Journal of Pain
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    • 제5권1호
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    • pp.117-120
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    • 1992
  • 본 통증치료실에서 요통 및 하지 방사통을 호소하는 30세된 남자환자를 보통 시행하는 횟수 보다 많은 경막외강내 스테로이드 주입중에 발생한 양측 무혈성 골두괴사를 경험하였다. 물론 이 환자는 약국이나 한약방 등에서 약명미상의 약물을 경구투여받고 있었으므로 그것(혹시 스테로이드)으로 인한 원인인지 혹은 단순히 경막외강으로 주입된 스테로이드로 인한것인지는 분명하지 않다. 그러나 최근 피부과 질환으로 인한 스테로이드의 장기복용 및 도포로 무혈성 대퇴골두괴사가 종종 보고되고 있으므로 그 원인일수도 있다는 가정하에 통증치료실에 근무하는 종사자들의 주의를 요하는 뜻에서 이 증례를 보고하는 바이다.

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폐경 후 류마티스 관절염 여성의 골량감소 판별요인 (Determinants of Reduced Bone Mass in Postmenopausal Women with Rheumatoid Arthritis)

  • 이은남
    • 재활간호학회지
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    • 제2권2호
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    • pp.193-205
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    • 1999
  • This study was carried out to identify the important risk factors for reduced bone mass of postmenopausal RA patients and to develop discriminant function which can classify postmenopausal RA patients with either reduced or normal bone mass. Through the literature review, individual characteristics such as age, body weight, height, age of menarche, duration of menopause, gravity, parity, and breast feeding period and factors of life style such as milk consumption exercise habit, alcohol intake, cigarette smoking, coffee consumpt ion , disease activity, corticosteroid therapy were identified as influencing factors of reduced bone mass in RA patients Sixty eight postmenopausal women with rheumatoid arthritis aged between 42 and 76 were selected among those who checked bone mineral density in lumbar spine and femur from october, 1998 to Apr il, 1999 at Dong-a university hospital in Pusan. Assessment of disease activity, duration of disease and corticosteroid therapy were made by the same rheumatologist and included Ritchie articular index, erythrocyte sedimentation rate, and C-reactive protein on measuring bone mineral density. Cumulative steroid dosage was calculated from the daily dosage multiplied by t h e number of days received. The information of other risk factor including health assessment score, individual characteristics and life style factors were collected by questionnaire. Bone mineral density(BMD) was measured using DXA at lumbar spine and femoral Ward's triangle. Discriminant function(regression equation) was developed for estimating the likelihood of the presence or absence of reduced bone mass. The results are as follows: Among the subjects, thirteen(19.1%) exhibited osteoporosis in lumbar spine and twenty four(35.3%) exhibited osteoporosis in femoral Ward's triangle. For lumbar spine, the variables significant were age, body weight, health assessment score, while for femoral Ward's triangle, age, body weight, duration of disease. But disease activity and corticosteroid therapy were not signigicant to distinguish reduced bone mass from normal bone mass. When the discriminant function was evaluated by comparing the observed out come with predicted out come, the discriminant function correctly classified 85.4% of patients with reduce bone mass and 63.0% of patients with normal bone mass in the lumbar spine and 100% of patients with reduced bone mass and 9.1% of patients with normal bone mass in the femoral Ward's triangle. In summary, we found that osteoporosis in postmenopausal women with RA is more evident at the femur than the lumbar spine. Also the important discriminant factors of reduced bone mass postmenopausal women with RA were age, body weight , duration of disease and health disability. In nursing situation, the efforts to improve of functional capacity of postmenopausal women with rheumatoid arthritis should be considered to prevent osteoporosis and fractures. Also we recommend those postmenopausal women with RA who are classified as a group of the reduced bone mass in the discriminant function should examine the bone mineral density to further examine the usefulness of this discriminant function.

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Comparison of conservative therapy and steroid therapy for Bell's palsy in children

  • Yoo, Hye Won;Yoon, Lira;Kim, Hye Young;Kwak, Min Jung;Park, Kyung Hee;Bae, Mi Hye;Lee, Yunjin;Nam, Sang Ook;Kim, Young Mi
    • Clinical and Experimental Pediatrics
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    • 제61권10호
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    • pp.332-337
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    • 2018
  • Purpose: Bell's palsy is characterized by sudden onset of unilateral facial weakness. The use of corticosteroids for childhood Bell's palsy is controversial. This study aimed to identify clinical characteristics, etiology, and laboratory findings in childhood Bell's palsy, and to evaluate the efficacy of corticosteroid treatment. Methods: We conducted a retrospective analysis of children under 19 years of age treated for Bell's palsy between January 2009 and June 2017, and followed up for over 1 month. Clinical characteristics, neuroimaging data, laboratory findings, treatments, and outcomes were reviewed. Patients with Bell's palsy were divided into groups with (group 1) and without (group 2) corticosteroid treatment. Differences in onset age, sex, laterality, infection and vaccination history, degree of facial nerve palsy, and prognosis after treatment between the groups were analyzed. Results: One hundred patients were included. Mean age at presentation was $7.4{\pm}5.62years$. A total of 73 patients (73%) received corticosteroids with or without intravenous antiviral agents, and 27 (27%) received only supportive treatment. There was no significant difference in the severity, laboratory findings, or neuroimaging findings between the groups. Significant improvement was observed in 68 (93.2%) and 26 patients (96.3%) in groups 1 and 2, respectively; this rate was not significantly different between the groups (P=0.48). Conclusion: Childhood Bell's palsy showed good prognosis with or without corticosteroid treatment; there was no difference in prognosis between treated and untreated groups. Steroid therapy in childhood Bell's palsy may not significantly improve outcomes.

역설적 성대운동을 보이는 3명의 환자에 대한 임상분석 (Clinical Evaluation of 3 patients with Paradoxical Vocal Cord Movement)

  • 최선명;임길채;한광우;남순열
    • 대한기관식도과학회지
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    • 제9권1호
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    • pp.83-86
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    • 2003
  • Background and Objectives : Paradoxical vocal cord movement is a series of paroxysmal adduction of the anterior two-thirds of the vocal cords during respiration or during phonation. The choking, stridor, and wheezing in this condition occur primarily on inhalation, rather than on exhalation. The two pathognomonic diagnostic criterias that need to be assessed during an acute presentation are laryngoscopy with direct visualization of paradoxical adduction of the vocal cords and pulmonary function testing. Materials and Methods : A retrospective review of 3 patients who were referred to otolaryngologist from pulmonology department, and were confirmed by typical laryngoscopic findings with paradoxical adduction of the vocal cords was conducted. Results The patients were misdiagnosed as exercised-induced asthma, and unresponsive to corticosteroid and bronchodilators. Improvement was achieved only by diagnosis with paradoxial vocal cord movement. Biofeed back therapy, voice therapy, treatment for reflux laryngitis improved symptoms. Conclusion The etiology of paradoxical vocal cord movement is unknown. It may be functional or emotional. The functional factors that were proposed are neurologic deficit and gastroesophageal reflux. Management methods of this condition consist of psychological counselling, voice therapy, and antireflux medication.

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Methimazole에 의한 재생불량성빈혈(再生不良性貧血) - 증례보고(症例報告) 및 문헌고찰(文獻考察) (Aplastic Anemia Secondary to Methimazole-Case Report and Review-)

  • 홍기석;이권전;김병국;고창순;이문호
    • 대한핵의학회지
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    • 제11권1호
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    • pp.71-75
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    • 1977
  • A case is reported of aplastic anemia occuring during Methimazole therapy. Since this seems to be a kind of self-limiting disease having considerably rapid recovery, much more detailed supportive therapy is considered to be crucial rather than any other corticosteroid or the androgen therapy.

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Comprehensive Approaches to Shoulder Impingement Syndrome: From Diagnosis to Rehabilitation

  • Jung-Ho Lee
    • International Journal of Advanced Culture Technology
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    • 제12권2호
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    • pp.90-97
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    • 2024
  • Shoulder impingement syndrome (SIS) is a common musculoskeletal condition characterized by pain and functional limitation due to the impingement of subacromial structures. This comprehensive review elucidates the complex nature of SIS, covering its pathophysiology, diagnostic methodologies, treatment options, and preventive measures. Through an exhaustive examination of current literature and clinical practices, the review highlights the importance of a multifaceted approach to SIS management. Physical therapy plays a pivotal role, focusing on exercises to strengthen shoulder musculature, enhance scapular stability, and improve range of motion. The review also discusses the strategic use of medications such as NSAIDs and corticosteroid injections, emphasizing their effectiveness in pain and inflammation management. Additionally, it advocates for structured rehabilitation programs post-treatment to restore function and prevent recurrence, recommending preventive strategies like ergonomic adjustments, targeted exercises, and proper technique training. This paper underscores the need for personalized and evidence-based treatment strategies, integrating physical therapy and pharmacological management when necessary.