A study of cortisol metabolism in patients with chronic asthma.

Abstract

SUMMARYThe mortality rate in asthma is rising and, in our hospital, the majority of deaths occur during episodes of status asthmaticus in steroid‐treated patients. Clinical observations have indicated that relatively large doses of cortisol are necessary to treat acute episodes of asthma in the long‐term‐steroid‐treated patient. Studies on 10 patients indicate that the plasma cortisol response to the intravenous injection of cortisol is less than normal in steroid‐treated patients, and that this reduced response is associated with a lack of clinical improvement.A good clinical response in steroid‐treated patients does not occur until the plasma cortisol level is at least 100 µg. per 100 ml. Studies of cortisol metabolism in the case of these 10 patients demonstrate an increased rate of removal of cortisol. The metabolic clearance rate of cortisol is higher than in normal subjects and in non‐steroid‐treated asthmatic patients. The metabolic clearance rate of cortisol is not affected by the administration of ACTH, but is reduced in steroid‐treated patients who are simultaneously receiving æstrogen therapy. These studies indicate the need to administer an initial relatively large dose of cortisol to steroid‐treated asthmatic patients in status asthmaticus.