Cases | 5 | 6 | 7 |
Age (sex) | 59 (M) | 51 (F) | 48 (M) |
Ethic group | Indian | Caucasian | Caucasian |
Smoking (pack yrs) | No | No | No |
Main complaint | Exacerbating asthma | Exacerbating asthma | Exacerbating asthma |
Past medical history | Asthma Nasal polyps/rhinitis Aspirin allergy | Sinusitis Atopic asthma Polycystic ovary syndrome HTN, GERD+ VCD+ | Asthma from childhood hay fever |
Atopic | Aspirin grass | Mites, pollen, dander | Grass |
Duration of asthma (yrs) | 10 | 12 | 45 |
Duration of difficult asthma (months) at referral | 72 | 21 | 24 |
Total daily dose inhaled steroids (µg) | 800 | 1000 | 1000 |
Current medication+ | BDP/formoterol Avamys nasal spray montelukast | FP/formoterol Salbutamol Losartan Indapamide Montelukast Mirtazepine Momentasone | FP/serevent Montelukast cetirizine |
Regular use of nasal steroids | Yes | Yes | Seasonal |
Duration of rhinitis (yrs) | Lifelong | 6 | Lifelong |
Regular need for oral steroids (yrs) | 4 yrs | 2 yrs | 2 yrs |
Best PEFR (% predicted) | 75% | 85% | 77% |
Best FEV-1 (% predicted) | 59% | 76% | 59% |
Best FVC (% predicted) | 69% | 82% | 82% |
9 am cortisol nmol/l (normal range 250 - 450 nmol/l) | 35 | 5 | 62 |
Synacthen test rise at 30 minutes nmol/l | 178 | 191 | 170 |
ACTH level during synathen test ng/l (normal range 10 - 50 ng/l) | 7 | 7 | 14 |
Hydrocortisone replacement mg daily dose | 15 mg | 30 | 10 |
No of exacerbations since hydrocortisone treatment | 2 viral | 0 | 4 |
No. of steroid courses since hydrocortisone acetate commenced | 2 short courses post viral Activation | 0 | 4 |
Duration of follow-up on hydrocortisone | 2.5 yrs | 2.5 | 2.5 yrs |
Hospital admissions since hydrocortisone | Nil | Nil | Nil |