Adrenal Insufficiency and Severe Brittle Asthma

I have severe brittle asthma which is managed by the specialist unit in Birmingham Heartlands Hospital. I was diagnosed with Adrenal Insufficiency earlier this year, thought to be caused by repeated steroid doses. This is causing me some stresses over my asthma management. Just wondered if anyone else has experience of managing both conditions? I you do I would love to hear from you!

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  • Hiya! I think quite a few of us on here are adrenal insufficient thanks to high dose pred, and there is also a theory that as adrenal insufficiency causes issues with inflammation that some of us may have asthma caused by the AI. I know as well that co-management is important and some people find asthma greatly improves once adrenal stuff is managed correctly, its complicated i find managing my adrenal stuff when im on high doses of steroids for my asthma, i also often find that esp in A&E they don't understand how to manage the steroids when i have both conditions, so find i have to be very knowledgeable, and hae had lots of discussions with my endo cons about what to advice people to do (as they really do ask me what to do, a bit stressful really!!)

    Are there any specific issues you come up against? DO you have an endo cons? what meds are you on? I find the best two pieces of advice i have been given are ""if in doubt - you cant really OD on steroids"" and ""ignore the adrenal stuff when dealing with the asthma as the HC just brings you up to baseline"" I do know that different people do get different advice, so obviously you need to check with whoever manages the endo side of things for you (GP/endo cons), ive never heard a contradiction to the first one (although im sure there must be some) but i know that different people are told very different things for the second one (Curiouser for example no longer uses pred, just manages asthma symptoms by altering her daily doses of HC - hopefully she'll pop up and give a bit of her usual wisdom!!) but for me, those two setences advice me of how to manage most situations: If an A&E cons doesnt know how to prescibe pred to me, i tell them to ignore my HC dose. If i cant work out if in crisis, i take some more steroids, its pretty simple most of the time, but there are the odd tricky situations. Then it helps to have a good team that you can easily get hoild of (and its times like that where the first piece of advice comes in handy - when you have to do something NOW!!) anyway, if you have any specific things that trip you up, feel free to ask! but you're not alone! i do find it hard to manage everything all at once, but like anything, habits build up over time and that helps to manage things!

    hope you're well at the moment :-) soph x

  • Thanks for a speedy reply Soph,

    I have an Endo Consultant and a Respiratory Consultant. Endo Consultant has been very clear; don't mess with the hydrocortisone, treat with prednisolone for asthma as and when necessary. Stress dose for any infection, trauma using sick day rules. Am generally coping well on 20mg hydrocortisone spilt into 3 doses. 10, 5, 5.

    Over last 5/6 days asthma symptoms increasing, but very slowly. I have been much worse than this many many times. But, now I'm worried if I don't treat the asthma with extra steroid it will trigger an adrenal crisis. Surely wheezing and increased inflammation will be putting an extra strain on my adrenals? I just haven't got a good feel for when to take action yet. Have been using slightly increased dose of HC in the hot weather as I was getting a lot of dizzy spells, headaches and tummy pain and that has helped the AI symptoms. Could really do without asthma kicking off too right now. Had a right royal lecture from daughter tonight on seeing GP and starting rescue pred and antibiotic. Find the GP clueless though.

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