So, I've had multiple hospital attendances recently due to this Chest Infection. Was put on antibiotics, but had an Asthma Exacerbation anyway so attended again as home nebulisers weren't enough. So asked if I should add Prednisolone on top of my Hydrocortisone. No one knows the answer. And I don't know what to do. Every time I've had an exacerbation since starting Hydrocortisone no one knows what to do with me.
I was told by an endocrinology reg. to double my Hydrocortisone for my Adrenal Insufficiency, so I'm at 50mg total for that right now (20-20-10), but what about the Asthma Exacerbation? Do I carry on as I am with the Hydrocortisone or ad 40mg Prednisolone like I would've done in the past? Or less? None? This is all so confusing and no one wants to give me a straight answer!
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Hey there! Fellow adrenal insufficiency and severe asthma patient here. I can share what I do.
When I'm sick, I follow sick day rules to double or triple HC depending on whether it's a cold, a bad fever, a gastro etc. If you haven't seen this guide, I've found it very helpful: addisonsdisease.org.uk/newl...
When I have an asthma exacerbation and need a dose of pred because my nebulizer isn't cutting it, I go off the HC and start the pred tapering down from 50 mg a day over 7-10 days depending on how bad it is and what my GP says.
When I get down to 5 mg of pred a day, I switch back to HC.
Hope that helps! I totally get and empathize with all the confusion. I'm in a bad flare now and may have to start a course of pred today even though I just tapered off one two weeks ago.
Apparently 1mg of Prednisolone doesn't equate to 1mg of IV/oral hydrocortisone, with Pred having more potency. Your doctor would have to look at the values of the hydrocortisone that you're currently on and establish what dose of Pred you can safely take in addition, if they deemed that to be the way to treat your asthma exacerbation.
Ideally, your asthma doctor should be discussing your treatment with the endocrinologist in order to figure out a way to treat your asthma while you have adrenal deficiency - if they're not going to use Prednisolone, then they should explain that to you and the reasons why they have decided that. Leaving you untreated, and in the dark, is not acceptable.
They could look at a long course of a macrolide antibiotic if they wanted to avoid steroids, as it can have additional anti-inflammatory properties - they just need to test your sputum in order to establish if you're a suitable candidate. In fact, a sputum test sounds like it's long overdue.
You may wish to discuss things over with the Asthma UK nurses before your next appointment, so that you're better prepared to assert your need for additional asthma treatment with your doctor.
I originally thought that I had to take my prednisolone and some hydro and some Consultants do do that however mine just put up my prednisolone to 40mg or 50mg and that's it.
Personally I think they should be kept as two different conditions as I feel I can struggle when it happens but that's just what the Consultants say.
I would have thought Prednisolone would be better as it has better inflammatory properties but I'm no doctor.
Sorry not to know the answer but I completely sympathise.
I agree with Dino40 and have the same difficulties as you, the advice I get is always conflicting and I’ve written to the Endocrine Society to highlight the need for guidance for patients like us.
I contacted the pituitary foundation and spoke to the clinical nurse specialist and she said that Addison’s/Adrenal Insufficiency and asthma should be treated as 2 separate conditions.
The hydrocortisone we take, is a replacement dose for what we don’t produce, so if we have an asthma flare, and are prescribed 40mg it’s really like being prescribed 35mg - if we didn’t have Addison’s disease/Adrenal Insufficiency , we would be producing cortisol and would be prescribed the 40mg of prednisolone in addition to what our body produces.
Prednisolone isn’t recommended for treating Addison’s disease/Adrenal Insufficiency as a once daily dose, as it’s action as cortisol usually only lasts 6-8 hours leaving people with low cortisol symptoms as the day progresses.
Personally for me (I’m not medically trained) I continue with my usual hydrocortisone dose and add in 40mg prednisolone for an asthma flare. If I just have prednisolone I experience low cortisol symptoms. By continuing your usual hydrocortisone dose, this is only the equivalent of 4-5mg of prednisolone and ensures that I don’t have low cortisol symptoms, plus when the course of prednisolone has been completed, there’s no risk of you having no steroid cover should you forget to re-start your hydrocortisone.
I understand the rationale for this, and the Clinical Nurse Specialist from the Pituitary Foundation said that she wished that more medical professionals thought this way.
There really needs to be some guidance though as the consultants involved with my care all have a different opinion, but I go by how I feel, and I know my body best.
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