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)
Michiko Haida, MD PhD, Akihiko Hashiguchi, BS, Katsutoshi Ogawa, PharmD, Takahiro Inoue, MD PhD, Bruce G. Bender, PhD FAAAAI
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.