Steroid Dependent Asthma (SDA); its variable presentation

B. H. Shakur, C. J. Corrigan, H. A. Jones, A. Spanevello, T. Krausz, P. W. Ind, R. J. Shiner

Research output: Contribution to journalArticle

Abstract

SDA is a disabling, uncommon, high resource-use condition which is poorly characterised. We have recruited 27 asthmatic patients with Chest Physician diagnosed asthma (16 female), mean [SD] age 50 [11] y. Three were current and 12 ex-smokers with a mean of 12 [16] pack y. Mean age of asthma diagnosis was 25 [19] y and mean age of commencement of systemic steroid therapy was 40 [14] y. Fourteen patients (52%) had evidence of atopy and a family history of atopy was noted in 15 (56%). Mean daily prednisolone dose was 19 [15] mg taken for 11 [8] y in addition to inhaled steroids (BDP or equivalent) 1844 [742]μg daily. All patients used inhaled short acting β2 agonists as required. Nebulised, subcutaneous and long acting β2 agonists were taken by 14, 3 and 18 patients respectively. 14 patients were treated with anticholinergics and 12 with xanthines. 93% of patients continued to experience night-time and daytime symptoms despite therapy. Lung function was consistent with residual airflow obstruction and hyperinflation. Physiological parameters mean SD FEV1% pred 55 23 current reversibility to salbutamol 2.5 mg(%) 21 17 RV (% pred) 141 33 KCO (% pred) 118 28 PEFR variability % (AM to PM) 15 19 AM PEFR variation between days 30 14 Laboratory results serum IgE (total) IU/ml 326 536 blood eosinophils (total) 470 800 sputum neutrophils % 60 29 sputum eosinophils 13 18 sputum macrophages% 23 25 We conclude that SDA is associated with a variable clinical and laboratory picture. Despite treatment with high dosages of oral and inhaled steroids patients remain symptomatic but generally stable. Airway obstruction and airway inflammation persist as reflected in sputum neutrophilia in most patients and significant (>2%) sputum eosinophilia in a majority of these patients.

Original languageEnglish
JournalThorax
Volume54
Issue numberSUPPL. 3
Publication statusPublished - Dec 1999

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Shakur, B. H., Corrigan, C. J., Jones, H. A., Spanevello, A., Krausz, T., Ind, P. W., & Shiner, R. J. (1999). Steroid Dependent Asthma (SDA); its variable presentation. Thorax, 54(SUPPL. 3).