Methotrexate is not suggested as a replacement for taking corticosteriods by mouth ("steroid sparing") due to the adverse effects associated with taking methotrexate and the minimal relief provided for asthma symptoms. Macrolide antibiotics, particularly the azalide macrolide azithromycin, are a recently added GINA-recommended treatment option for both eosinophilic and non-eosinophilic severe, refractory asthma based on azithromycins efficacy in reducing moderate and severe exacerbations combined. Azithromycins mechanism of action is not established, and could involve  pathogen- and/or host-directed anti-inflammatory activities. Limited clinical observations suggest that some patients with new-onset asthma and with "difficult-to-treat" asthma (including those with the asthma-COPD overlap syndrome - ACOS) may respond dramatically to azithromycin. However, these groups of asthma patients have not been studied in randomized treatment trials and patient selection needs to be carefully individualized.For children with asthma which is well-controlled on combination therapy of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA), the benefits and harms of stopping LABA and stepping down to ICS-only therapy are uncertain. In adults who have stable asthma while they are taking a combination of LABA and inhaled corticosteroids (ICS), stopping LABA may increase the risk of asthma exacerbations that require treatment with corticosteroids by mouth. Stopping LABA probably makes little or no important difference to asthma control or asthma-related quality of life. Whether or not stopping LABA increases the risk of serious adverse events or exacerbations requiring an emergency department visit or hospitalisation is uncertain.
Noritate is a topical cream usually prescribed for rosacea, a disease of the skin commonly associated with adult acne and most notably frequent to constant flushing of the face around the cheeks and chin area.Noritate contains 1% anti-inflammatory drug metronidazole designed to reduce redness in inflamed areas. While noritate may get rid of some pustules and reduce redness, it has been shown to result in acne in an exceptionally small number of users. The drug information pamphlet claims only 1% of users see ill effects. In many cases, users see no reduction in general redness associated with rosacea and sometimes even a worsening effect. Similar results are reported for Metrogel, which contains the same 1% metronidazole. == References ==