Overcoming Steroid Insensitivity in Respiratory Disease

ISBN: 9780470058084 出版年：2008 页码：310 Ian Adcock Kian Fan Chung Wiley

Asthma specialists have made great strides during the past 60 years. With the implementation of glucocorticosteroids and improved therapeutic ratios with inhaled corticosteroids, asthmatic patients have seen great improvements in disease control. During the past decade, researchers have intensified the examination of asthmatic phenotypes and have begun to explore their genetic contribution to asthma. Not all asthmatic patients, however, respond to corticosteroids. This subgroup of nonresponders accounts for a disproportionate amount of health care utilization. However, much of the present research focuses on this asthmatic phenotype. Overcoming Steroid Insensitivity in Respiratory Disease, a wonderful addition to any asthma specialist’s library, focuses on the rapidly growing literature regarding corticosteroidinsensitive asthmatic patients. The editors have assembled a world-class list of authors to examine the topic in detail, reviewing the literature for asthma and chronic obstructive pulmonary disease. This text comprises 14 chapters with more than 1,000 references. It begins by reviewing the glucocorticoid receptor and then builds on the topic by exploring the mechanisms of glucocorticosteroid effect and how insensitivity may occur. This text includes discussion of dissociated glucocorticosteroid (glucocorticosteroid ligands that retain the beneficial aspects while decreasing the adverse effects) and review of potential environmental exposures that can alter the asthmatic phenotype to a glucocorticosteroid-resistant state. Several chapters are devoted to corticosteroid-sparing agents, including recent studies regarding tumor necrosis factor blockade and modulation of transcription factors such as nuclear factor. These chapters will be a great resource for the asthma specialist grappling with caring for the glucocorticosteroidinsensitive patient. To be complete, the authors also explore newer inhaler devices, including newer-generation nebulizers, to discuss optimal glucocorticosteroid delivery to the lungs.