Bronchial asthma is a chronic disease of the respiratory system, in which there is a strong narrowing of the bronchi. Asthma hormones are needed to provide anti-inflammatory and anti-allergic effects.
Glucocorticosteroids are included in the basic therapy of asthma . If they are not used to treat the disease, dependence on symptomatic bronchodilators increases greatly . This is a sign of uncontrolled asthma.
What are glucocorticosteroids
Glucocorticosteroids are hormones produced by the adrenal cortex. The human body produces cortisol, corticosterone .
The versatile effect of these biologically active substances on the body has made it possible to actively use them in the treatment of various diseases, including asthma.
A number of fluorinated and non- fluorinated synthetic glucocorticoids now exist . Unlike natural ones, they are more active, therefore they act more effectively.
Mechanism of action of GCS
To fully understand why asthma hormones are used so actively, it is important to know their mechanism of action. In the cells of the human body, there are special receptors with which glucocorticosteroids bind, penetrating into the cytoplasm.
The complex obtained as a result of this interaction penetrates into the nucleus, where it acts directly on the DNA. This allows you to activate the formation of various proteins:
- lipocortin-1. Its action is aimed at inhibiting the production of arachidonic acid, from which inflammatory mediators are synthesized;
- neutral endopeptidase . It is necessary for the destruction of kinin complexes that take part in the development of the inflammatory process;
- interleukin-10, which has anti-inflammatory effects;
- a nuclear factor inhibitor. Plays an important role in inhibiting the inflammatory process of the bronchi.
Due to the action of the hormone-receptor complex, a pronounced inhibition of the formation of proteins activating the inflammatory process is observed.
Glucocorticoids, due to their properties, perfectly help with bronchial asthma, giving a pronounced anti-inflammatory effect.
Use of glucocorticosteroids in asthma treatment
The use of glucocorticoids in bronchial asthma is a traditional method of treating this disease. Their use began in the mid-40s of the twentieth century, after F. Hench and E. Kendall were able to artificially synthesize GCS.
Realizing that glucocorticosteroids help in controlling the inflammatory process in hormonal asthma, they began to actively test them in the treatment of the disease, however, they noted a large number of side effects and temporarily discontinued their use.
In modern medicine, asthmatics are prescribed two types of hormonal drugs: inhalation and systemic GCS.
The main advantages explaining the widespread use of inhaled glucocorticosteroids (ICS) for the treatment of bronchial asthma are high lipophilicity , short half-life, and rapid inactivation.
The following ICS are used in clinical practice:
- beclomethasone dipropionate ;
- budesonide ;
- mometasone furoate ;
- fluticasone propionate;
- ciclesonide .
The mechanism of action of ICS in bronchial asthma is based on their high lipophilicity . The epithelium of the human bronchi is covered with a small layer of fluid.
Therefore, not all substances can quickly penetrate this barrier. Lipophilicity allows the drug to quickly reach the bronchial mucosa and enter the circulatory system.
The effect of the use of inhaled glucocorticoids directly depends on the method by which they were delivered to the body.
So, when using inhalers with aerosols, most of the drug is deposited in the oral cavity or swallowed. Only 10% reaches directly the bronchial mucosa.
Inhalation of the drug through a spacer – about 5%. ICS enter the systemic circulation in the form of inactive metabolic products, with the exception of beclomethasone . The administration of drugs through a nebulizer is also used for certain groups of patients, namely:
- aged people;
- people with impaired consciousness;
- patients with severe bronchial obstruction.
According to a number of clinical trials, inhaled glucocorticosteroids are extremely effective in bronchial asthma.
Systemic glucocorticosteroids (SGCS) are not emergency drugs for bronchial asthma, but they are extremely important for therapeutic measures during exacerbations. In general, they are needed to improve the patient’s quality of life and do not have a quick effect.
According to the global strategy of the WHO, it is extremely important to use SCS for all but the mildest exacerbations of asthma. This is especially true in the following cases:
- after the introduction of ICS, there is no improvement in the patient’s condition;
- the attack began despite taking ICS;
- an increase in the dose of ICS is required;
- the patient’s condition is constantly deteriorating;
- decrease in the body’s response to the action of ICS;
- decrease in peak flow metrics (PSV below 60%)
It is noted that for long-term therapy, it is better to use SGCS in the form of tablets, intravenous administration is more often used during an attack. The main glucocorticosteroids used for systemic therapy for bronchial asthma are prednisolone and hydrocortisone.
When taken orally, an extremely high bioavailability is noted. The maximum concentration of drugs in the blood when administered intravenously is achieved less than an hour after ingestion.
In the liver, these drugs are metabolized and then excreted in the urine.
Side effects of glucocorticosteroids
When treating patients with hormone-dependent bronchial asthma, it is important to remember that GCS have a number of side effects, which can be divided into two groups:
- Diseases developing during therapy.
- Developing after stopping treatment (withdrawal syndrome).
The first group includes the following consequences:
- metabolic disorders;
- increased blood pressure;
- decreased immune status;
- peptic ulcer;
- mental disorders;
- growth disorders in children;
- cushingoid .
Metabolic disorders are manifested in the form of hyperglycemia, a violation of fat and water-electrolyte metabolism. The increase in blood sugar levels is due to the fact that against the background of taking GCS, there is an increase in tissue resistance to the action of insulin.
At the same time, this condition is observed quite rarely, and people who, in addition to hormonal asthma, suffer from diabetes mellitus are more prone to it.
Fat metabolism disorders are manifested in the excessive development of adipose tissue on the face and trunk. The so-called cushingoid habitus is developing .
Disorders of water and mineral metabolism are manifested in the form of water retention in the body and the loss of calcium and potassium.
Arterial hypertension when taking corticosteroids is associated with their effect on the walls of blood vessels. It develops with long-term treatment with large doses of drugs.
Peptic ulcer disease occurs even less often. That is why all patients who use SGKS in the treatment of asthma should be examined for the presence of stomach ulcers.
Some patients using GCS may experience muscle weakness, up to complete atrophy. This is directly related to the effect of drugs on mineral metabolism. Also, myopathy can be observed with cushingoid , so it cannot be called a specific side effect.
Mild mental disorders can be observed at the earliest initiation of GCS therapy. So, patients have nervousness, frequent mood swings, and sleep disturbances. Steroid psychoses are extremely rare.
Growth disorders may occur in children when using SGKS. Boys are especially prone to this. It is believed that the pathology is associated with a violation of the production of sex hormones.
Withdrawal symptoms include fatigue, lack of appetite, fever, nausea, and severe headaches. In some cases, adrenal insufficiency may occur. The clinic of pseudotumor of the brain is extremely rare .
Is it possible to treat asthma without the use of hormones
The first thing that people with hormone-dependent bronchial asthma should understand is that they cannot independently refuse the use of GCS. Treatment should be systemic and under the supervision of a specialist.
If we talk about the treatment of asthma without hormonal drugs, then we need to remember about such a group of drugs as cromones . It should be understood that these drugs have a more prophylactic rather than a curative effect.
They are recommended for use during remission. There are many forms of cromones , but the best effect is obtained with inhalers. They have several advantages:
- ease of use;
- lack of addiction;
- minimal risk of side effects.
Due to their properties, cromoglycic acid preparations are excellent for the prevention of asthma attacks in children with a mild form of the disease. They are the drug of choice in accordance with the WHO global strategy.
According to the studies, if in moderate and severe asthma the use of ICS does not raise any questions, then at the initial stages their use is not justified.
Treatment of asthma without hormones in an adult who has been using steroids for a long time is almost impossible.
It is important to use medications such as ICS and SGKS in the treatment of bronchial asthma under the supervision of a physician. The drugs must be selected individually, and the treatment itself must be systemic.
In case of exacerbations of asthma, it is recommended to use ICS to relieve the attack, and then, if necessary, connect the SCS. Despite the risk of side effects, these drugs are the best treatment for asthma.