Adrenal insufficiency in severe asthma. Comparison with mild to moderate asthma and other related allergic diseases.
Sunday, March 4, 2018
South Hall A2 (Convention Center)
RATIONALE: Severe asthma under high dose systemic steroid(SS) may have adrenal insufficiency/crisis (AI/AC) after cessation of SS. Cortisol (CS) replacement therapy could be life saving in period of stress. Analysis for possible AI/AC was done in severe asthmatics and were compared to other groups of patients. METHODS: Total of 47 patients studied were grouped as follows. Group A(G-A): severe asthma, with long term SS,N=23[N=14,with antibody therapy, N=9,without antibody therapy];Group-B(G-B) :mild to moderate asthma without long term SS,N=10;Group-C(G-C) : asthma-like allergic diseases with moderate use of SS[N=7];Group-D(G-D): Non-asthma with minimal SS for rhinitis and other allergic diseases[N=7].Diurnal variation (DIU-CS) for ACTH and CS at 6:00,11:00,16:00,23:00;24hr urinary cortisol (24hrUC) were done for 2 days followed by rapid ACTH test after cessation of all SS/CS for 3 days. RESULTS: G-A had higher chances for having early childhood asthma(p=0.0005), recurrence in adulthood(p=0.0052), episode of sudden exacerbation(p=0.00), sinusitis(p=0.0032), past hospital admission(p=0.0044),use of steroid(p=0.0006),low 24 hrUC(p=0.0029).DIU-CS was lowest in G-A(4.1,5.6,4.2,1.3), followed by G-B (8.9,7.6,6.3,1.8),G-C(9.1,4.7,3.9,1.4),G-D(12.0,8.6,7.2,3.1)( μg/ml).G-A had lowest average level and differed significantly at several points with G-B(6:00,P=0.02,16:00,P=0.04) and G-D(6:00,P=0.0023,11:00,P=0.0269,16:00.P=0.0319), but no difference was observed at any point with G-C. Peak and all points in rapid ACTH was lowest in G-A (peak, 12.7), followed by G-C(peak,21.8),G-D(peak23.1) and G-B(peak 28.9)(μg/ml).Data from all aspects displayed significantly low CS status for G-A followed by G-C,G-B and G-D. CONCLUSIONS: Severe asthmatics may have unexpectedly high chance of AI/AC.Similar profile was found for those with asthma like allergic diseases as well.Presence of AI/AC should be monitored closely for early diagnosis and optimal replacement therapy.