Corticosteroids for acute severe asthma

Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae ( S. pneumoniae ) meningitis ( RR , 95% CI to ), but not in Haemophilus influenzae ( H. influenzae ) or Neisseria meningitidis ( N. meningitidis ) meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae meningitis ( RR , 95% CI to ) but not in children with meningitis due to non- Haemophilus species.

Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile . [43] The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception . [44] In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone. [45] The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field. [46] The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.

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  • Citation tools Download this article to citation manager Sadeghirad Behnam , Siemieniuk Reed A C , Brignardello-Petersen Romina , Papola Davide , Lytvyn Lyubov , Vandvik Per Olav et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials BMJ 2017; 358 :j3887
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    We identified 20 trials with 12,303 randomised participants. The effect of corticosteroids on the risk of death was reported in 17 included trials. Due to significant heterogeneity we did not calculate a pooled estimate of the risk of death. The largest trial , with about 80% of all randomised participants, found a significant increase in the risk ratio of death with steroids (95% CI to ) and a relative risk of death or severe disability of (95% CI to ). For infections the pooled risk ratio from five trials was (95% CI to ) and for the ten trials reporting gastrointestinal bleeding (95% CI to ).

    Corticosteroids for acute severe asthma

    corticosteroids for acute severe asthma

    We identified 20 trials with 12,303 randomised participants. The effect of corticosteroids on the risk of death was reported in 17 included trials. Due to significant heterogeneity we did not calculate a pooled estimate of the risk of death. The largest trial , with about 80% of all randomised participants, found a significant increase in the risk ratio of death with steroids (95% CI to ) and a relative risk of death or severe disability of (95% CI to ). For infections the pooled risk ratio from five trials was (95% CI to ) and for the ten trials reporting gastrointestinal bleeding (95% CI to ).

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