I have severe asthma and was diagnosed with adrenal insufficiency in 2020 after taking lots of Pred when Covid triggered my asthma. I was just left on 5mg Pred for two years with no endocrinology involvement.
I was eventually transferred to an endocrinologist who tried me on hydrocortisone tablets (I don't need the daily Pred for my breathing anymore). But I kept getting a sore chest and palpitations so switched back to the Pred.
I went to hospital about a month ago with what I thought was an adrenal crisis (turns out it wasn't) but while I was there they tried me on the HC tablets again and they kept me in for a few days. They made my asthma worse again to the point I needed a couple of nebulisers. There was one doctor in particular who just wouldn't accept it was the HC tablets triggering it and wouldn't contact my respiratory team who'd already told me not to take them anymore.
So I came out of hospital, went back on the Pred for my AI about 5 weeks ago and was feeling better. Then three weeks ago I developed some shortness of breath and I'm finding daily activities more difficult than I used to and getting a pain/soreness between my shoulder blades. I did have a wheezy chest but that's gone, however every day follows the same pattern where I wake up, don't feel too bad, take my Pred, then I develop a tickly/throaty cough, then my chest gets sore and tight and I end up with the pain between my shoulders by the end of the day through breathing harder.
I'm concerned that I may have become sensitised to the Pred after what happened in hospital as I cannot explain why I am feeling like this. My asthma is usually ok at this time of year and I have no infections, I have tested negative for Covid. If it is the Pred obviously this has consequences for both my asthma treatment and my AI, as I usually need extra steroids in the summer when I am usually worse.
My respiratory team are also refusing to accept it's the Pred, I am seeing the GP tomorrow for an examination but talking to her on the phone she also doesn't think it's the Pred. It's not like I can stop taking it because I need it for my adrenal problem.
I have looked into allergy services but I don't know if something like this can be tested for? I am hoping we can have a go at tapering off the steroid so I don't need them but that can take months.
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Hydrocortisone is not as potent as Prednisolone and that may explain any asthma flare if you're on a low dose of HC. But that doesn't explain subsequent flares from new Prednisolone courses.
Can we become intolerant to our meds, or build a tolerance to Prednisolone? According to Dr Google, there's an acknowledgement that some people are allergic to Pred, but there's little or no research on building a long term tolerance and so it's assumed to be unlikely. Big assumption.
Some people are allergic to Prednisolone, but reactions would show up at the start of the treatment rather than years into the treatment. Having said that, my experience of Prednisolone has changed over the years, in that I don't do well on it as I used to years ago, BUT I think that is more down to the way doses are administered now. My consultant now recommends I take Azithromycin rather than Pred for any winter flare up and the results are so much better. They decided on Azithromycin after establishing my phenotype, non-eosinophilic with a twist (I barely understand the twist).
Your story illustrates how much asthma, and our reaction to treatments, can differ from patient to patient. But we're stuck with an almost one size fits all asthma treatment plan unless we're fortunate enough to have a consultant or specialist who thinks outside the box.
Sorry my response is so unhelpful and I hope others who have experience of adrenal insufficiency and difficult asthma share their experiences with you.
No I think what you say is true. I have found I need multiple courses of rescue packs as I've got older as one isn't enough anymore. My concern with the daily Pred is that I may have become sensitised to it when I was taking it in hospital alongside the HC tablets which were the one provoking the breathlessness. My GP, respiratory and endo team all refuse to accept this is possible so it looks like I will have to go down the private route of allergy testing. My argument is: if it's not causing a reaction then that proves they are right, but they won't even send me for any drug allergy testing. Very frustrating.
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