Efficacy/risk profile of triamcinolone acetonide in severe asthma: Lessons from one case study

Summary 

Some prednisone-resistant asthma patients respond to intramuscular triamcinolone acetonide (TA). The use of TA has been questioned on the basis of its potential toxicity. TA's ratio of clinical efficacy to systemic effects compared with oral prednisone has not been clearly defined.

We report the case of a prednisone-insensitive severe asthma patient with insulin-dependent diabetes, hypertension and diabetic retinopathy treated with repeated sessions of laser therapy. By daily monitoring the needs of insulin doses we compared the systemic effects of prednisone and TA.

The analysis of the balance between systemic effects (insulin doses) and beneficial effects (PEF values) show that TA has a better benefit/risk profile than prednisone. The patient has been followed up for 3 years and has received injections of TA repeated at intervals ranging from 21 to 60 days according to patient response and the evolution of PEF and clinical symptoms. During this period the patient lost 3kg of weight, while presenting increased bone mineral density, normalized arterial tension, and improved proliferative diabetic retinopathy.

The present case report shows that TA has a better benefit/risk profile than prednisone. TA can be a valuable alternative in the control of some patients with severe prednisone-resistant asthma.

Keywords: Insulin, Refractory asthma, Severe asthma, Steroid-dependent asthma, Triamcinolone acetonide