Cases | 1 | 2 | 3 | 4 |
Age (sex) | 49 (F) | 49 (F) | 45 (F) | 54 (F) |
Ethic group | Caucasian | Caucasian | Caucasian | Caucasian |
Smoking (pack yrs) | Ex 4 yrs (15) | Ex 5 yrs (10) | Ex 9 yrs (25) | Ex-3 (40) |
Main complaint | Exacerbating asthma | Exacerbating asthma | Exacerbating asthma | Exacerbating asthma |
Past medical history | Atopic asthma Aspirin allergy Chronic rhinosinusitis Nasal polyps polypectomies | Atopic asthma Rhinosinusitis Nasal polyps Otitis media Vocal cord nodules polypectomies | Atopic asthma Hayfever Hypersensitivity pneumonitis Depression and anxiety Iron deficiency GERD Obesity, ↑ cholesterol | Atopic asthma Vocal cord dysfunction Lumbar disc disease depression hypothyroid high cholestrol |
Atopic | Grass mites tree moulds | Grass tree mites moulds | Grass cat | Grass, dander, mites |
Duration of asthma (yrs) | 34 | lifelong | 15 | 30 |
Duration of difficult asthma (months) at referral | 12 | 18 | 12 | 18 |
Total daily dose inhaled steroids (µg) | 1000 | 1600 | 2000 | 1600 |
Medication | FP/serevent+ Betnosol nasal drops Montelukast doxycycline | BDP/formoterol+ montelukast Betnosol Doxycycline Vitamin D | BDP/formoterol+ BDP (extra without formoterol) Simvastatin Omeprazole amitriptyline | BDP/formoterol+ tiotropium aminophylline carbocisteine lansoprazole salbutamol fluoxetine thyroxine |
Regular use of nasal steroids | Yes | Yes | Seasonal | No |
Duration of rhinitis (yrs) | 34 yrs | 20 yrs+ | Seasonal | None |
Regular need for oral steroids (yrs) prior to referral | 1 yr | 1.5 yr | 1 yr | 4 yrs |
Best PEFR (% predicted) | 93% | 125% | 97% | 85% |
Best FEV-1 (% predicted) | 95% | 97% | 80% | 86% |
Best FVC (% predicted) | 85% | 96% | 90% | 82% |
9am cortisol (normal range 250 - 450 nmol/l) | 11 | 120 | 129 | 11 |
Synacthen test (Cortisol rise at 30 minutes nmol/l) | 20 | 69 | 46 | 99 |
ACTH level during synathen test ng/l (normal range 10 - 50 ng/l) | <5 | <5 | 24 | <5 |
Hydrocortisone replacement dose in mg daily | 20 | 30 | 20 | 30 |
No of exacerbations since hydrocortisone treatment | 0 | 0 | 0 | 1 |
No. of steroid courses since hydrocortisone acetate commenced | 0 | 0 | 0 | 1 |
Duration of follow-up on hydrocortisone | 3 yrs | 2.5 yr | 3 yrs | 1.5 yrs |
Hospital admissions Since hydrocortisone | Nil | Nil | Nil | 1 |