PREDNISOLONE METABOLISM TEST

PREDNISOLONE METABOLISM TEST

Aim: 

To assess prednisolone metabolism in steroid dependent asthmatics

Justification:

Small group of asthmatics remain symptomatic despite long term treatment with oral corticosteroids “prednisolone”, with major implication in terms of steroid induced side effects.  The cause of this lack of effect could be due to poor adherence, malabsorption, rapid metabolism or genetically mediated resistance to steroids.  The aim of this test is to assess the cause of the apparent lack of responsiveness to steroids in a patient.

Procedure:

  • Collect 5ml blood for baseline measurement into a plain/ gel tube (“clotted sample”) at approximately 8.30am.
    Label “Pre-Prednisolone – 8.30am”
  • Administer standardised dose (0.5mg/kg) of Prednisolone. E.g. 60kg = 30mg. “this need to be directly observed by a medical staff” at 8.30 am.
  • Collect 1 sample of 5ml of blood at 9.00am, and then 5ml samples at 10.00 am, 11.00 am, 12.00pm.
  • Please label accurately each sample time on the tube.

Sample Requirements:

  • Total of 6 samples.
  • Serum (yellow or red top tube)
  • Minimum volume of each sample = 5ml whole blood

Request Form:

  • One request form should be completed for all samples.
  • Request ‘STEROID ABSORPTION TEST’. F.A.O: Ms Joanne Heynes.
  • State time of sample on each bottle.
  • Transport to Clinical Biochemistry, BHH.

Notes:

  • Please ensure patient does not take their morning dose of prednisolone prior to starting the test.

Please record the following clinical information and send to the laboratory with the samples:

  1. 1. Steroid dependent asthma:  Yes  /  No  (Asthma classification:                      )
  2. 2. Asthma Control (yes / no): Good, suboptimal, poor
  3. 3. Adherence compliance:
    1.  a: All the time,  b: most of the time, c: good amount of time, d: sometimes, e: not at all
  4. 4. Is patient on theophylline: Yes / No.  If yes what is the dose, serum level
  5. 5. What is the baseline prednisolone dose:……mg/day,duration:…..months….years.
    1. Frequency of increase of dose over last 12 months…….
  6. 6. Steroid side effects
    1. Truncal obesity: yes/no, 
    2. Pink striae yes/no,
    3. Moon face  yes/no,
    4. Skin bruising  yes/no,
    5. Cataract  yes/no,
    6. Osteoporosis  yes/no,
    7. Diabetes mellitus yes/no,
    8. Hypertension yes/no,
    9. IHD yes/no,
    10. Previous evidence of adrenal suppression.
  7. 7. Asthma responsiveness of prednisolone: yes/no , any steroid reversibility trial
  8. 8.  Peripheral blood eosinophil……., exhaled nitric oxide……, FEV1……. (%pred….)
  9. 9. sex,   age,    weight,      height,        BMI
  10. 10.  Smoking history: never smoked, exsmoker….., current smoker… Pack yrs.
  11. 11. Which category the patient fall in:
    • a) Slim patient with no steroid toxicity and poor asthma control
    • b) Slim patient with steroid toxicity and poor asthma control
    • c) Clinically cushinoid with steroid toxicity and good asthma control
    • d) Clinically cushinoid with steroid toxicity and poor asthma control
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HTA licence number is 12366

Protection of Personal Information – Laboratory Medicine comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235

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