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