L Regard, P C Lazureanu, B Pascal, G Laurichesse, C Rolland-Debord
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[Efficacy and toxicity of short-course corticosteroid therapy in chronic bronchial diseases].
Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway inflammation. While corticosteroids (CS) are frequently prescribed during exacerbations of these conditions, their repeated use is associated with numerous side effects. The aim of this review is to synthesize the recent literature on the indications, benefits, and risks of short-term CS therapy for these two diseases. French guidelines recommend short-term CS as a first-line treatment during asthma exacerbation (0,5 to 1mg/kg/day, not exceeding 60mg/day, for at least 5 to 7 days) or as a second-line treatment for COPD exacerbation (5 days, 30 to 40mg/day). However, these recommendations are not without limitations; they are primarily based on studies conducted in hospital settings, raising questions about the generalizability of their results to primary care, and as they employ a "one size fits all" strategy, they do not take into account the phenotypic heterogeneity of different patients. Moreover, repeated short-term CS courses generate side effects that even at low doses can appear early in young asthma patients, and they can exacerbate pre-existing comorbidities in COPD patients. The concept of a threshold dose should be employed in routine practice in view of accurately assessing the risk of side effects. In the near future, it will be important to consider recently published data supporting the use of predictive biomarkers for responses to CS, particularly in COPD cases.
期刊介绍:
La Revue des Maladies Respiratoires est l''organe officiel d''expression scientifique de la Société de Pneumologie de Langue Française (SPLF). Il s''agit d''un média professionnel francophone, à vocation internationale et accessible ici.
La Revue des Maladies Respiratoires est un outil de formation professionnelle post-universitaire pour l''ensemble de la communauté pneumologique francophone. Elle publie sur son site différentes variétés d''articles scientifiques concernant la Pneumologie :
- Editoriaux,
- Articles originaux,
- Revues générales,
- Articles de synthèses,
- Recommandations d''experts et textes de consensus,
- Séries thématiques,
- Cas cliniques,
- Articles « images et diagnostics »,
- Fiches techniques,
- Lettres à la rédaction.