Mechanisms of glucocorticoid action and insensitivity in airways disease

Pulm Pharmacol Ther. 2014 Dec;29(2):129-43. doi: 10.1016/j.pupt.2014.08.008. Epub 2014 Sep 9.


Glucocorticoids are the mainstay for the treatment of chronic inflammatory diseases including asthma and chronic obstructive pulmonary disease (COPD). However, it has been recognized that glucocorticoids do not work well in certain patient populations suggesting reduced sensitivity. The ultimate biologic responses to glucocorticoids are determined by not only the concentration of glucocorticoids but also the differences between individuals in glucocorticoid sensitivity, which is influenced by multiple factors. Studies are emerging to understand these mechanisms in detail, which would help in increasing glucocorticoid sensitivity in patients with chronic airways disease. This review aims to highlight both classical and emerging concepts of the anti-inflammatory mechanisms of glucocorticoids and also review some novel strategies to overcome steroid insensitivity in airways disease.

Keywords: Asthma; Chronic airway diseases; Combination therapy; Glucocorticoid; Inflammation; Steroid resistance.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / drug therapy
  • Glucocorticoids / therapeutic use*
  • Humans
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Receptors, Glucocorticoid / drug effects
  • Respiratory Tract Diseases / drug therapy*
  • Signal Transduction / drug effects
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Receptors, Glucocorticoid