STEROID SENSITIVITY IN BRONCHIAL ASTHMA

DOI: https://doi.org/None

S.V. Chubarova (1), I.А. Yakovchuk (2), А.Yu. Kraposhina (1), I.A. Soloveva (1), I.V. Demko (1), A.B. Salmina (1) 1 -Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky, Partizana Zheleznyaka, 1, Krasnoyarsk, 660022, Russian Federation; 2 -Scientific Research Institute of Medical Problems of the North, Partizana Zheleznyaka, 1, Krasnoyarsk, 660022, Russian Federation

The main purpose of the treatment of bronchial asthma is achievement and maintenance of the control over the symptoms of disease at optimal level. For this purpose in terms of basic therapy there is used inhalation of as glucocorticosteroids as well systemic glucocorticosteroids if necessary. However in a large number of patients symptoms of asthma are controlled dissatisfactory in spite of existence of the high performance therapy. The steroid resistance is the major barrier of effective treatment. In this literature review there are presented the most studied causes of the decline of sensitivity to glucocorticosteroids. According to modern views there are two types of steroid resistance in bronchial asthma: primary and secondary. The primary steroid resistance to glucocorticosteroids, as a rule, is a result of genetic polymorphism, disruption of the affinity and nuclear translocation of the glucocorticosteroid receptor. The secondary steroid resistance to glucocorticosteroids is acquired, develops in the course of the treatment and can undergo miosis. Furthermore it may be the corollary of the prolonged exposure of a variety of inflammatory factors. Inasmuch as the resistance to anti-inflammatory effect of glucocorticoids in bronchial asthma and other chronic inflammatory diseases is poorly understood, it is therefore important to study mechanisms of the development of steroid resistance. A clear understanding of the molecular mechanisms of the reduction of steroid sensitivity will allow in the near future to identify both markers of steroid resistance and prognostic criteria for the evaluation of the effectiveness of treatment in patients with bronchial asthma. More recently, P-glycoprotein is considered as a potential target to overcome drug resistance as a result of the use of modulators of its activity. This opens new perspectives in the treatment and gives the opportunity to deliver and improve the rational therapy.
Keywords: 
bronchial asthma, steroid resistance, steroid sensitivity, glucocorticosteroids
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