To assess prednisolone metabolism in steroid dependent asthmatics


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.


  • 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.


  • 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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The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link:

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
  • United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation 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 test information, please visit the test database:

Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act  1998 and associated best practice and guidance.

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