The existence of adrenal dysfunction in asthmatic patients remains controversial. Assessing adrenal function in these patients is difficult because of varying severity and duration of attacks and large fluctuations in the secretion of adrenocortical hormones. Total and free (unbound) levels of serum cortisol and cortisone were measured in asthmatic children and healthy controls using reversed-phase high performance liquid chromatography. The results were correlated with the severity and duration of asthma attacks. In asthmatic patients in remission, total and free concentrations of cortisol and cortisone did not differ significantly from those in healthy controls. During attacks, levels increased in proportion to the severity of the attack. These values decreased to control levels after 24 h. However, in children with attacks lasting for more than 5 days, values remained significantly decreased with no relation to the severity of the attack.
Conclusion: During an asthma attack, adrenocortical hormone concentrations increase in proportion to the severity of the attack but subsequently decrease with time. It is speculated that the inability to sustain an elevated cortisol level may lead to the persistent asthma attacks.