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(Chest. 1998;114:1349-1356.)
© 1998 American College of Chest Physicians

Benefits of High-dose IV Immunoglobulin in Patients With Severe Steroid-Dependent Asthma

Lawrence P. Landwehr MD1; John D. Jeppson MD1; Michael G. Katlan MD2; Beth Esterl RN1; David McCormick PhD3; Daniel L. Hamilos MD2; and Erwin W. Gelfand MD1

1 From the Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO.
2 From the Department of Medicine, National Jewish Medical and Research Center, Denver, CO.
3 From the Department of Biostatistics, National Jewish Medical and Research Center, Denver, CO.

Erwin W. Gelfand, MD, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206; e-mail: gelfande{at}njc.org

Study objective: To determine the efficacy of IV immunoglobulin (IVIg) in severe asthma to reduce steroid requirements.

Design: Pre- and posttreatment measurements were analyzed using Dunnett's multiple comparison procedure.

Setting: Hospital clinical research center.

Patients: Eleven adolescents and adults with severe, steroid-dependent asthma enrolled over a 14-month period.

Interventions: IVIg was administered at a dose of 2 g/kg every 4 weeks for a total of seven infusions.

Measurements and results: Steroid requirements, pulmonary function including lung volumes, symptom scores, bone densitometry, and airway reactivity monitored by methacholine challenge were followed over the course of 7 months. A significant decrease in steroid usage was achieved. Despite substantial steroid reduction, the patients demonstrated improvement in their pulmonary function and symptom scores. The responses to methacholine challenge were unaffected by IVIg treatment.

Conclusions: IVIg provides a potentially important adjunctive therapy in severe asthma, reducing oral steroid requirements and steroid side effects without deterioration of lung function.

Key Words: asthma • IV gammaglobulin • steroid-dependent

Submitted on April 20, 1998
Accepted on June 25, 1998




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