An improved protocol for the use of troleandomycin (TAO) in the treatment of steroid-requiring asthma.

An improved protocol was developed for the use of troleandomycin (TAO) in severe, steroid-requiring subjects with asthma. Compared to previous reports, this protocol uses a lower starting dose of TAO and a rapid steroid taper. Fifteen patients were treated with TAO following the new guidelines. Steroid requirements in the 15 patients dropped by 68% within 2 weeks, and 13 of the 15 patients were able to be maintained on alternate day steroids. In spite of rapid steroid taper, both FEV1 and mean FVC increased significantly (p less than 0.001). There was a low incidence of side effects and, in contrast to previous reports on TAO, no patient had even a transient increase in cushingoid appearance. Glucose intolerance was observed initially in three patients but resolved with continued steroid taper. Transient liver-enzyme elevation was noted in four patients and in each case reversed with a reduction in TAO dosage. The revised protocol is associated with an improved risk-benefit ratio. New guidelines are presented for the use of TAO in severe steroid-requiring subjects with asthma.