Your Blood May Predict Steroid Resistance

Steroid resistance may not be known until the treatment fails for asthma patients. Blood testing may help predict resistance so asthma patients can choose the right treatment.

Blood testing could be used to determine if an asthma patient is steroid resistant or steroid sensitive.

This could help steroid resistant asthmatics choose different anti-inflammatory medication before treatments like inhaled corticosteroids fail.

Ask your doctor about alternative anti-inflammatory asthma treatments.

The study was led by Elena Goleva, Ph.D., from the Division of Pediatric Allergy and Immunology at National Jewish Health in Denver and involved 19 asthma patients. Lung function was measured using a Forced Expiratory Volume (FEV1) test. An oral steroid was given to the 19 participants for seven days. Blood was collected at the start of the study and 30 days after the oral steroid treatment.

The 19 asthma patients were determined to be steroid resistant or steroid sensitive depending on the FEV1 score after the oral steroid treatment. FEV1 measures how much air is exhaled in one second. The oral steroid would improve lung function and improve the FEV1 score for steroid sensitive asthma patients and not steroid resistant asthma patients.

The blood that was collected from the 19 asthma patients, was cultured with dexamethasone, a synthetic steroid, to determine the development of steroid-related genes and proteins as well as the response from the cells to the steroid.

The oral steroid was effective in improving FEV1 score for steroid sensitive asthma sufferers but not for steroid resistant asthma patients. Higher levels of protein enzymes that cause cellular division and cell-signaling proteins produced by white blood cells were present in steroid resistant asthma patients.

The effectiveness of dexamethasone was also reduced in steroid resistant asthma patients. There were more glucocorticoid β receptors expressed, which would bind to the dexamethasone, being produced in the steroid resistant asthma patients when compared to steroid sensitive participants. More dexamethasone was needed to suppress the T-cells (white blood cells), in steroid resistant asthma patients.

What this means for asthma sufferers is that blood tests can be effective in determining steroid resistance as there are a number of markers that can lead a doctor to conclude resistance. Future tests can expand the number of participants involved to gain a better understanding of how effective blood testing is for predicting steroid resistance.

By being able to predict steroid resistance, asthma sufferers do not need to buy inhaled corticosteroids that will ultimately fail. This failure could lead to bigger problems for asthma sufferers. Determining a steroid resistance can allow doctors to lead the asthma sufferer to alternative anti-inflammatory medication to treat their asthma. 

Funding for the study was provided by Genentech Inc. and National Institutes of Health.

This study was published in the March edition of The Journal of Allergy and Clinical Immunology.