Article Text


P235 Prednisolone/cortisol Spot Test Of Non-adherence In Corticosteroid-dependent Asthma
  1. Adel Mansur
  1. Heartlands Hospital, Birmingham, UK


Background About 40% of severe asthmatics require maintenance oral corticosteroids (OCS) for disease control. However, significant proportion of these patients continues to have poor disease control due to OCS unresponsiveness or non-adherence (Gamble 2009).

Methods Using a validated in-house developed liquid chromatography/mass tandem spectrometry (LQ/MSMS), we conducted spot measurement of serum prednisolone, prednisone and cortisol in 111 patients attending our severe asthma clinic over a 12 months period. Patients not on maintenance OCS comprised the control group. Suppressed cortisol (20nmol/l, were considered as compatible with adherence to OCS, whilst unsuppressed cortisol and undetectable prednisolone were considered as non-adherent. For validation purposes the test was repeated multiple times in few cases.

Results The prednisolone/cortisol spot test was conducted on 111 patients (79% females) with 44 (40%) were not on regular OCS (control group) and 67 (60%) on maintenance OCS. The spot test revealed non-adherence in 27/67 (40%) of patients and adherence in 40/67 (60%) of patients. The prednisolone/prednisone/cortisol assays were similar in non-adherent group and non-OCS group (figure). The mean daily prednisolone dose was 16.3, 20.1, and 0.0 mgs in the adherent, non-adherent and non-OCS groups respectively. Non-adherent patients had lower BMI, and higher exacerbations frequency, blood eosinophil count, and fraction exhaled nitric oxide than OCS adherent group. The non-adherent group resembled more the non-OCS group with regard to aforementioned parameters.

We conclude that this prednisolone/cortisol spot test is reproducible and diagnostic of non-adherence to OCS in 40% of patients on maintenance OCS, and should be routinely measured in severe asthma clinics to improve patients management.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.