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Decreased Glucocorticoid Binding Affinity to Glucocorticoid Receptor Is Important in the Poor Response to Steroid Therapy of Older-Aged Patients with Severe Bronchial Asthma

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The aim of this study was to determine whether alterations in glucocorticoid (GC) to GC receptor (GC/GCR) binding affinity and the state of airway remodeling contribute to the poor response to GC therapy of severe bronchial asthma patients in old age. Peripheral blood mononuclear cells were obtained from two groups with severe asthma, 10 patients with steroid resistant (SR), 7 patients with steroid sensitive (SS), and 6 normal controls. GC/GCR binding affinity for dexamethasone was determined by using a radioligand binding assay with Scatchard analysis, and bronchial wall thickness in high-resolution computed tomography was used to determine the degree of airway remodeling. SR patients had decreased GC/GCR binding affinity (Kd = 24.3 ± 9.55; p < 0.05) compared with the SS patients (Kd = 13.5 ± 1.48; p < 0.05) and the normal controls (Kd = 4.24 ± 1.09). The inner diameter of bronchi and the thickness of the bronchial wall of segmental and subsegmental bronchi were increased significantly in patients compared with normal controls. However, no significant differences were found between the SR and SS patients. Our results suggest that decreased GC/GCR binding affinity may be an important factor of clinical GC resistance in the acute exacerbation of chronic severe asthma in older-aged bronchial asthma patients.
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Document Type: Original Article

Publication date: September 1, 2003

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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