- Coren ME,
- Rosenthal M,
- Bush A
Purpose of the Study
To describe the authors' experience in using cyclosporin in 5 children with steroid-dependent asthma.
Five children 8 to 15 years of age with poorly controlled asthma despite high-dose inhaled steroids and at least 10 mg of oral prednisone daily. All had been skin-tested with appropriate environmental controls instituted. In addition, all had normal immunoglobulin levels, sweat tests, and pH probes, ruling out complicating or alternative diagnoses.
Open trial of cyclosporin 5 mg/kg daily.
Case 1, 8-year-old girl: no better after 6 months, no side effects.
Case 2, 15-year-old girl: monthly prednisone decreased from 900 mg to 200 mg, stopped because of severe hirsutism.
Case 3, 8-year-old girl: monthly prednisone initially decreased from 800 mg to 200 mg but relapsed while still on cyclosporin, mild hirsutism.
Case 4, 9-year-old boy: monthly prednisone decreased from 750 mg to 0, decreased glomerular filtration rate but no increase in creatinine or blood pressure, major improvement in height and weight.
Case 5, 10-year-old girl: monthly prednisone decreased from 300 mg to 0, mild hirsutism, major improvement in height and weight.
Cyclosporin may be useful in refractory childhood asthma. A prospective study is required to confirm this.
With current asthma therapy including high-dose inhaled corticosteroids, very few patients require regular oral corticosteroids. In those few who are steroid-dependent, cyclosporin, which inhibits helper T cell function, may be an effective alternative. Cyclosporin is not without potential side effects (hirsutism, paraesthesia, headache, hypertension, renal toxicity) and looses its effectiveness if stopped. Risks and benefits must be weighed against those of oral steroids.