Oral corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

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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.

In one study , oral corticosteroids at prednisolone-equivalent dose of 1 mg/kg alternate days slowed progression of lung disease; at two and four years, % predicted FEV 1 in the 1 mg/kg group changed significantly more than in the placebo group ( P < ). During the first two years, the 2 mg/kg group was not significantly different from the placebo group. Linear growth retardation was observed from six months in the 2 mg/kg alternate days prednisolone group and from 24 months in the 1 mg/kg alternate days prednisolone group.

La bronchopneumopathie chronique obstructive (BPCO) est un trouble pulmonaire progressif et commun associé à une limitation généralement irréversible du flux respiratoire. Les corticostéroïdes améliorent la limitation du flux respiratoire liée à l'asthme et ont été testés dans la BPCO. Cette revue a observé que le traitement aux stéroïdes oraux améliorait la fonction pulmonaire et les symptômes par rapport au placebo, mais que tous les individus n'en bénéficiaient pas de la même manière. L'utilisation à long terme ne ralentissait pas le déclin de la fonction pulmonaire, et un risque accru d'effets secondaires était observé, notamment du diabète et de l’ostéoporose.

Oral corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

oral corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

La bronchopneumopathie chronique obstructive (BPCO) est un trouble pulmonaire progressif et commun associé à une limitation généralement irréversible du flux respiratoire. Les corticostéroïdes améliorent la limitation du flux respiratoire liée à l'asthme et ont été testés dans la BPCO. Cette revue a observé que le traitement aux stéroïdes oraux améliorait la fonction pulmonaire et les symptômes par rapport au placebo, mais que tous les individus n'en bénéficiaient pas de la même manière. L'utilisation à long terme ne ralentissait pas le déclin de la fonction pulmonaire, et un risque accru d'effets secondaires était observé, notamment du diabète et de l’ostéoporose.

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