cortisol-succinate--sodium-salt and Bronchial-Spasm

The surgical treatment of emphysematous lung bullae is usually contraindicated in patients with severe bronchial asthma. However, we recently encountered a patient who required surgery due to the development of respiratory distress despite treatment with bronchodilators and low-dose prednisolone (5 mg/day). During the first operation, bronchospasm occurred with anesthesia. After suppression of the asthmatic symptoms for 2 weeks with high-dose prednisolone (25 mg/day), the giant bullae could be resected safely. Thus, the preoperative resolution of asthma to decrease the probability of an attack is indispensable for such patients.

Topics: Adult; Aminophylline; Anti-Inflammatory Agents; Asthma; Bronchial Spasm; Bronchodilator Agents; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Hydrocortisone; Intraoperative Complications; Male; Prednisolone; Premedication; Pulmonary Emphysema; Tomography, X-Ray Computed

This is a report of a male patient who had an anaphylaxia-like reaction to hydrocortisone sodium hemisuccinate (Solu-Cortef). A 32-year-old male with aspirin sensitivity was treated for moderate wheezing with 200 mg Solu-Cortef given intravenously. After this treatment, his condition deteriorated acutely and he was admitted to our hospital. Intradermal skin tests revealed positive immediate reactions to Solu-Cortef, Saxizon, Solu-Medrol and Predonine. Challenge tests with 100 mg Solu-Cortef and Saxizon injection showed 34% and 27% decrease, respectively in FEV1 15 min after injection. These results suggest that succinylation of steroids resulted in allergic reaction to steroids in this patient.

Topics: Adult; Aspirin; Asthma; Bronchial Spasm; Drug Hypersensitivity; Humans; Hydrocortisone; Infusions, Intravenous; Male

This is a report of a female patient who had an anaphylaxis-like reactions to hydrocortisone sodium succinate (Saxizon). A 31-year-old female with intrinsic bronchial asthma and aspirin sensitivity was admitted to our hospital because of an episode of asthmatic attack. The patient had had episodes of dyspnea since 1976, and had been treated with oral bronchodilators and intermittent corticosteroids. After admission, she was given 100 mg of hydrocortisone sodium succinate intravenously. A few minutes later she developed severe bronchospasm and lost consciousness. An endotracheal tube was inserted and she was mechanically ventilated for 2 hours. The patient recovered after 1 hour. An inhalation challenge test with Sulpyrin was positive. When the provocation challenge test with 100 mg of hydrocortisone sodium succinate (Saxizon) injection was performed, she developed subjective and objective evidence of bronchospasm. Intradermal skin test revealed positive immediate reactions to Saxizon, Solu-cortef, Predonine. It is suggested that she had immediate hypersensitivity to hydrocortisone sodium succinate, but the mechanism of this anaphylaxis-like reaction to steroids is not certain.

Topics: Adult; Aspirin; Asthma; Bronchial Spasm; Drug Hypersensitivity; Female; Humans; Hydrocortisone

Eleven patients with intrinsic asthma and aspirin sensitivity were challenged with intravenous hydrocortisone sodium succinate (Solu-Cortef; the Upjohn Co., Kalamazoo, Mich.). Three patients showed definite evidence of bronchospasm, which was easily reversed by subcutaneous administration of epinephrine. Evidence is presented which suggests that this reaction was not caused by other constituents of the preparation but rather was caused by Solu-Cortef alone. No atopy was demonstrated in the group as a whole, and the reaction observed was probably nonallergic in nature. We suggest the replacement of intravenous hydrocortisone sodium succinate with dexamethasone in the treatment of such a population.

Topics: Adult; Aspirin; Asthma; Bronchial Spasm; Dexamethasone; Female; Forced Expiratory Volume; Humans; Hydrocortisone; Injections, Intravenous; Male; Middle Aged; Vital Capacity