Hormone-resistant asthma

　　Corticosteroid-resistant asthma is a type of asthma. Some patients have poor asthma efficacy even if they are given corticosteroids for a long time or in high doses. This type of asthma is corticosteroid-resistant asthma. Currently, the cause of this disease is not yet fully clear.

　　Corticosteroid-resistant asthma is a type of asthma. Generally, this disease can lead to the following complications:

　　1. Long-term high-dose corticosteroid therapy can increase liver alanine aminotransferase, aspartate aminotransferase, and other enzymes. In addition, patients with corticosteroid-resistant asthma have abnormal skin vascular contraction reactions to corticosteroids, leading to skin petechiae, adrenal function suppression, and decreased bone density. Inhaled corticosteroid therapy can lead to complications such as hoarseness, throat discomfort, and candidiasis.

　　2. Due to hypoxia, inadequate intake, excessive sweating, etc., patients often have water, electrolyte, and acid-base balance disorders.

　　3. Severe asthma attacks can cause insufficient lung ventilation, infection, improper treatment and medication, and complications such as pneumothorax, atelectasis, and pulmonary edema.

　　Currently, there is no unified standard for the diagnosis of corticosteroid-resistant asthma (GRA). The main difference between different standards lies in the dose of corticosteroid treatment and the duration of treatment. GRA is generally defined as: Asthmatic patients with FEV1/pre％ ≤ 75% who have been treated with an appropriate dose of corticosteroids (such as oral prednisone 40mg/d) for 2 weeks and have an improvement in FEV1 of ≤15% can be defined as GRA; conversely, if the increase in FEV1 is >15%, it can be defined as GSA.

　　Compared with GSA, GRA has characteristics such as older age, longer medical history, more severe airway hyperreactivity, and a higher tendency to have nocturnal wheezing symptoms. In clinical practice, for asthmatic patients who have used a full dose of corticosteroids but still cannot control symptoms, we should be alert and discover and diagnose GRA early, avoid unnecessary use of corticosteroids, and take other alternative effective treatments to control asthma attacks.

　　To prevent the occurrence of this disease, clinical medical workers should be vigilant for asthmatic patients who have used a full dose of corticosteroids but still cannot control symptoms, so as to discover and diagnose corticosteroid-resistant asthma in a timely manner, stop the unnecessary use of corticosteroids, and avoid the side effects of corticosteroids. At the same time, the general public should also pay attention to preventing respiratory tract infections, avoiding overexertion, getting wet, running, and emotional stimulation. Strengthening exercises and enhancing physical fitness can improve the body's adaptability to the external environment.

　　This disease can generally be tested in the laboratory, and the increase of peripheral blood eosinophils can be seen through laboratory tests. There is no obvious abnormality in the chest X-ray of this disease, which can only be used as an auxiliary examination.

　　A reasonable diet can help the disease recover faster, and this is no exception for patients with hormone-resistant asthma. Let's take a look at the dietary principles for hormone-resistant asthma.

　　1. Correct malnutrition, trace allergens, and avoid eating suspected allergenic foods. A diet with high-quality and sufficient protein, vitamins, and high carbohydrates can be adopted, but the fat supply should be appropriate.

　　2. For obese patients, the fat supply should be low to achieve the purpose of reducing phlegm and dampness and appropriate weight loss. Obese patients have an upward movement of the diaphragm and a reduction in diaphragmatic mobility, which can worsen asthma.

　　3. To alleviate the difficulty of chewing and swallowing caused by respiratory distress, soft rice or semi-liquid (not containing hard and tough foods) can be consumed, which is conducive to digestion and absorption and can prevent food reflux.

　　4. Avoid eating gas-producing foods (such as sweet potatoes, chives, soybeans, bread, etc.) and use more alkaline foods.

　　5. According to the needs of the condition, increase the intake of fluids in various forms (such as drinks, soups, etc.) to prevent and correct dehydration, which is particularly important for febrile patients.

　　6. Increase the intake of calcium and iron in the diet. It is recommended to regularly consume braised pork ribs (or large bones) with radish and black fungus soup. This soup is nutritious and not greasy, with high calcium and iron content. Radish also has the function of clearing phlegm and promoting Qi, which is more suitable for asthma patients with excessive phlegm.

　　Since patients with hormone-resistant asthma are resistant to corticosteroid treatment, attention should be paid to the following points during treatment:

　　1. Bronchodilators

　　Bronchodilators are the first-line medication, which can be administered through inhalation, oral, subcutaneous, or intravenous injection. Long-acting beta-agonists can significantly dilate the bronchi and should be used in combination with other non-hormonal antiallergic drugs. Inhaled anticholinergic drugs have good efficacy in some patients with hormone-resistant asthma. Oral or intravenous theophylline can show a significant bronchodilatory effect in refractory asthma. Leukotriene modifiers have good efficacy in some patients, especially those with airway lesions or those allergic to aspirin.

　　2. Glucocorticoids

　　Patients have a very low responsiveness to long-term oral or intravenous administration of high-dose corticosteroids, at this time, the therapeutic value of corticosteroids is very limited. However, a few patients show a certain degree of responsiveness even under super-high-dose corticosteroids, and these patients can be treated with super-high-dose corticosteroids for a short period of time. But the use of super-high-dose corticosteroids may possibly lead to side effects such as Cushing's syndrome. Recently, new types of corticosteroid preparations such as RU24858 and RU40066 are expected to play a role in the treatment of this disease. Currently, inhaled preparations such as fluticasone and budesonide used in the treatment of asthma have strong anti-inflammatory effects and have a marked 'first-pass effect', thus reducing the systemic effects of corticosteroids and can be used clinically.

　　3. Methotrexate (MTX)

　　Methotrexate (MTX) can inhibit the airway's response to histamine and other inflammatory mediators, having a significant anti-inflammatory effect. Low-dose (15-50mg/week) methotrexate (MTX) can significantly reduce the dose of corticosteroids in patients with severe hormone-dependent asthma. The main side effects of methotrexate (MTX) are gastrointestinal reactions, and high-dose application has hepatotoxicity. In addition, it may also inhibit bone marrow, cause kidney damage, and cause rash. The use of methotrexate (MTX) in early pregnancy can lead to fetal malformation, abortion, stillbirth, or teratogenesis. However, there have been no reports of serious side effects with low-dose methotrexate (MTX) used for asthma treatment to date.

　　4. Cyclosporine

　　Cyclosporine (CyA) can significantly reduce the dose of corticosteroids in patients with hormone-dependent asthma, improve asthma symptoms, and reduce asthma attacks, but asthma may recur after the discontinuation of cyclosporine (CyA), so long-term use is required. The main side effects of cyclosporine (CyA) are nephrotoxicity and hypertension, as well as hirsutism, peripheral neuritis, hepatotoxicity, and headache. Although cyclosporine (CyA) seems to be an ideal treatment for GRA from both theoretical and clinical perspectives, its potential serious side effects and high cost limit its wide application. Its inhaled formulation has been proven to alleviate airway hyperreactivity in animals, but it has not yet been applied to humans.

　　5. Intravenous application of immunoglobulin

　　Intravenous immunoglobulin therapy for patients with severe hormone-dependent asthma can reduce the dose of corticosteroids, improve clinical symptoms and PEF, and weaken the skin reaction to specific allergens. However, there is a lack of research data on the dose and frequency of application, and the price is relatively high.

　　6. Leukotriene modifiers

　　Leukotriene modifiers can significantly reduce the number of eosinophils in blood and sputum, improve asthma symptoms, and have a different mode of action in inhibiting asthma inflammation from corticosteroids, which can be used to treat this disease.

　　7. Other drugs

　　Colchicine, dapsone, hydroxychloroquine, and acetylsalicylic acid are used to treat hormone-dependent asthma and can alleviate asthma symptoms. They may also have certain application value in the treatment of this disease.