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