Steriod dependance and steriod resistance

I was told a while ago i was steriod dependant and steriod resistancebut i took little notice of it. i have just moved home and got a new consultant who brought this up as i dpont look like someone who has been taken high dose steriods for three years.

i am a bit confused because how can you be dependant on something as well as resistant to it because my initial thought was resisiatnce = it doesnt work on the body and dependance to me wouldbe that the body relies on ti but how can you ahve both.

i am now goign to be tried on methotrexate (sp?) or somehting similar as a steriod sparing agent i ahve read the thread on it but just confused about the resistance thing.

thanks

olive

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Hi Olive

I don't think I can help with your question but have had a similar experience with my son. Although he has not been described as steroid dependant he is said to be steroid resistant. He had Kenalog injections over a 3 month period and still became ill requiring additional Pred so his consultant said he was clearly unresponsive to steroids at our appointment then admitted him for lousy lung function and started him on a 7 day course of Pred. Confusing or what!? My local queried it during his next admission and asked why he was being given steroids if they don't help. I just sat there looking sheepish, shrugging shoulders with nothing to say. I am sure we are not the only ones in this situation, perhaps someone else can she some light...

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Hi Olive,

Sorry to hear you're having problems. It can be confusing having these labels thrown around the place - I've had both labels too in the past. It's a relatively common situation that severe asthmatics will be classed as having both steroid dependence and a degree of steroid resistance.

Steroid resistant asthma refers to asthma that does not completely respond to high dose steroids, usually oral prednisolone. There is no universally accepted definition, but one commonly used one is 'failure of morning pre-reliever FEV1 by greater than 15% following 7-14 days of prednisolone at least 40mg daily'. Most people have a relative insensitivity to steroids rather than an absolute resistance - this means that they may partially respond or may respond well to much higher doses than would normally be required.

Steroid resistance is thought to be due to abnormalities in the steroid receptor in the body or in the way that the steroid binds to the receptor. It's not known what causes this abnormality. It's important to distinguish between true steroid resistance and other factors that may be making your asthma worse and difficult to treat - such as undiagnosed allergy, post-nasal drip or gastro-oesophageal reflux. It's also important to rule out problems with absorption of oral steroids from the gut - the fact that you don't look like you have been on steroids for three years may suggest an absorption problem. Some centres do run absorption studies to check on this - some people better absorb pred if they take the soluble version, or may benefit from steroid injections rather than tablets.

Steroid dependence simply means that your asthma deteriorates if you try to reduce or come off oral steroids. If you have had a partial response to oral steroids, but do not meet the criteria described above, it is possible to fall into the catagory of being both steroid dependent and steroid resistant - ie you are worse without the steroids but are not completely better when on them.

The main routes of treatment for both steroid resistant and steroid dependent asthma would be: investigation to look for other contributing factors such as allergy or reflux; maximisation of other asthma therapy such as montelukast or theophylline; consideration of steroid sparing agents such as methotrexate or ciclosporin.

Hope this helps and that the methotrexate does some good; if you want more info on methotrexate there have been a few threads on it in the past if you do a search.

Take care

Em H