hydrocortisone tablets and asthma

[ccccc]

Hello

I have adrenal insufficiency and my endocrinologist wants me to switch from 5mg Pred a day to Hydrocortisone tablets. I have severe asthma but the 5mg Pred is just for the AI.

Although I feel miles better on HC - I feel very sluggish and tired on Pred - I've tried two different brands of HC tablets and they keep triggering my asthma, although the way I'd describe it is my chest feels irritated and sore and I have a loose cough a few days later. The endo seems confused as he says HC is a steroid so it should have the opposite effect. I'm seeing the respiratory doctor in a few weeks so will ask him, but has anyone else encountered this? I've had HC injections and drips in the past without any issue - just seems to be the tablets. They contain lactose and maize starch. I don't drink milk as it causes IBS so is it the lactose? I'm really scratching my head. Anyone else had this?

[Homely2 Administrator]

We know that coming off long term pred too quickly can trigger all sorts of asthma symptoms.

Your endo will have worked out how much hydrocortisone is needed to replace the pred for adrenal purposes. However does your endo know how much hydrocortisone is needed to replace it for respiratory purposes.

If the hydrocortisone is not an adequate replacement for the pred, maybe you are suffering the normal asthmatic issues of being taken off longterm pred too quickly.

[ccccc in reply to Homely2]

Hi Homely2

I don't need the Pred for asthma - I was put on it a few years ago when I had Covid to help with my breathing. I feel a lot better now. At the moment I'm still taking 5mg Pred and adding in the HC dose (which is 20mg a day). So I haven't begun to withdraw the Pred yet.

[eachy]

I have a Salicylate and Amine intolerance, neither are listed on ingredients and both flare my asthma. You can ask the pharmacist to find out though. Fostair aerosol had Salicylates but not the nexthaler. As does one of the brands of fexofenadine. You just never know. Could try a different brand or graduate the transfer to HC, half the dose as pred and half HC, see if that helps?

[ccccc in reply to eachy]

Hi eachy

That's interesting you say that. I'm beginning to wonder if it's the lactose in the tablet. I will ask of there's a lactose-free version available.

[alexa_s]

From my knowledge (correct me if I'm wrong), prednisolone is long acting (24 hours) and hydrocortisone is short acting (up to 12 hours) for asthma. Are you taking the hydrocortisone morning and evening? It might be that your asthma is kept in check for only half the day, hence your symptoms.

[Ostrowta]

Hello. I was on long term prednisone for my asthma which I no longer needed for my breathing after starting Tezspire. However, I also have adrenal insufficiency. I did not do well on hydrocortisone and have switched back to prednisone. My dose is 5 mg in the am and 5 mg in the pm. Prednisone has a stronger anti-inflammatory benefit than hydrocortisone, but hydrocortisone has more mineralcorticoid benefits and is a closer mimic to our own natural cortisol. Prednisone also is 4x stronger, so 5 mg prednisone is equvalent to roughly 20 mg hydrocortisone. As to why your asthma symptoms seem to be worsening when you are taking both, I'm not sure. Are you doing more because you are feeling better with the hydrocortisone in your system? Best of luck in finding your answers.