Author: Emile F.L. Dubois

Source: Current Respiratory Medicine Reviews, Volume 1, Number 1, January 2005 , pp. 103-108(6)

Publisher: Bentham Science Publishers

Abstract:

Glucocorticoids (GC) are used in pulmonary medicine since the early nineteen-thirties; in the beginning by using extracts of adrenal glands of animals, later on synthetically composed and since the early nineteen-seventies in inhaled formulation. In pulmonary medicine the majority of prescriptions are related to asthma and exacerbations of COPD. In determining the pharmacological potency of the different GC's many efforts were made for quantification. In this respect in vitro, in vivo, ex vivo and clinical studies were performed. Examples in estimating the GC potency range from skin-blanching tests to suppressive effect on the adrenal gland, the latter representing 'a classical paradigm'. Thus far different quantifying attempts that have been made did not take into account the tissue concentration-effect relationship, which can be achieved by pharmacokinetic / pharmaco-dynamic (PK / PD) modelling. Moreover, in the clinical studies described, the suggestion was risen that GC's may have a different potency towards each target tissue separately and that the suppressive effect on the adrenal gland does not reflect for instance its anti-inflammatory action. In this respect the studies describe a quantifying inflammation model for asthma e.g. by granulocyte colony stimulating factor (GCSF) stimulated rise in eosinophilic cationic protein (ECP), which could be inhibited by different GC's.

In conclusion, studies on potencies of GC should comprise PK / PD modelling and should target as much as possible on the different outcome parameters of the therapeutical and adverse effects separately and simultaneously, thereby describing 'the spectrum of potency' of a GC rather than 'the potency'.

Keywords: adrenal gland; corticosteroids; inflammation; lymphocyte; cytokine

Document Type: Review article

DOI: http://dx.doi.org/10.2174/1573398052953604

Affiliations: 1: Department of Pulmonary Medicine, Hospital Reinier de Graaf Groep, Delft / Voorburg, p / a Fonteynenburghlaan 5, 2275 CX Voorburg, The Netherlands.

Publication date: 2005-01-01

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• Current Respiratory Medicine Reviews publishes frontier reviews on all the latest advances on respiratory diseases and its related areas e.g. pharmacology, pathogenesis, clinical care, and therapy. The journal's aim is to publish the highest quality review articles dedicated to clinical research in the field. The journal is essential reading for all researchers and clinicians in respiratory medicine.

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