[Two out-of-the-ordinary (?) case reports an asthmatic disease]

This is a report on two cases of asthmatic disease presented to a general practitioner. After a prolonged course of many years during which the intensity of asthma varied, Ms K. suffered from constantly recurring exacerbations that required treatment with systemic corticosteroids. The reason was found to be an adrenocortical insufficiency suspected to be of iatrogenic origin. After various treatment attempts an optimal minimal therapy was found resulting in complete freedom from complaints, namely, a combination of fluticasone and 3 mg methylprednisolone. However, brief instruction and group training as well as freedom from complaints remained unsuccessful in keeping the patient compliant. Mr Pl had been suffering from allergic asthma since early childhood which escalated in 1982. Beclomethasone diproprionate (BDP) and Budesonid were not tolerated (hoarseness), so that polypharmacy became necessary. This could only be reduced after finding out that Flunisolid (Fls) was tolerated, so that stabilisation was achieved. Complaints were greatly reduced with sole inhalation of Fls and salbutamol. After having changed over to fluticasone it became possible to reduce salbutamol as stabilisation progressed, so that salbutamol was used only if required. Depending on the intensity of allergen exposure, complaints now occur in February/March only, requiring updating of the therapy in respect of dosage and number of drugs used. During the remaining part of the year a minimal therapy using one stroke of 250 micrograms fluticasone was found sufficient to ensure lasting freedom from complaints. Both patients reduced or terminated the treatment of their own accord despite freedom from complaints under minimal therapy and were reconverted to therapy compliance only after the peak flow values had dropped or the complaints had returned.