Methotrexate Spares Steroids in Asthmatics

NEWARK, NJ - The airways are the passages in the lungs for the oxygen that we breathe. The walls of these passages become inflamed in the lungs of patients with asthma. This inflammation leads to spasm of the airways (bronchospasm), shortness of breath, and wheezing.

Steroid medications, such as prednisone and prednisolone, are often used in severe asthma to control the inflammation in the airways. These medications have many potential side effects. (For a review of these medications, please read the prednisone article of MedicineNet.com.)

Methotrexate is used for cancer treatment generally in higher doses than for other uses, and is often administered intravenously or intramuscularly. Among the other uses of methotrexate are the treatment of psoriasis (an inflammatory skin disease), as well as the arthritis that occurs in 10 percent of these patients (psoriatic arthritis), and rheumatoid arthritis.

A review of articles published to date related to treatment with methotrexate for the purpose of decreasing steroid requirements in adults with steroid-dependent asthma was published in the journal CHEST (1997;112:29-33).

This computer search review method has the advantage of being able to summarize a number of small studies in order to determine the statistical significance of their results when combined as one group.

The results showed that low-dose methotrexate treatment (15 mg per week) resulted in a decrease in prednisone or prednisolone usage by an average of nearly 5 mg per day, or around 24%.

The author, Matthew G. Marin, M.D. of the New Jersey Medical School, concluded that low-dose methotrexate does have a significant steroid-sparing effect in steroid-dependent asthma patients. Further long-term studies were recommended to determine the comparative scope of both steroid and methotrexate toxicities in patients with asthma.

The Medical Editors of MedicineNet.com emphasize that asthma can have more than one process actively causing the airways disease in an affected individual. These include spasm of the muscular walls, inflammation, and infection of the airways. Medical science will be developing better approaches to the treatment of asthma by addressing each of these processes.