[Severe asthma was found to be an asthma-like condition. Consider reduced doses of cortisone]. / Svor astma visade sig vara astmaliknande tillstånd. Beakta möjligheten sänka kortisondosen.

A middle-aged man with variable breathing problems and frequent acute attacks, diagnosed as severe bronchial asthma, was given high-dose oral corticosteroid treatment. Owing to the somewhat atypical history, and normal lung function test results despite severe concomitant asthma-like symptoms, the diagnosis was reconsidered. As a new diagnostic work-up showed the presence of a disease of slight to moderate severity, it was decided to taper off the corticosteroid treatment. Within one year the daily dose of prednisolone was decreased from 40 to 7.5 mg without deterioration of the airway symptoms or impairment of lung function. Re-evaluation also showed the principal diagnosis not to be bronchial asthma but an asthma-like condition (functional breathing disorder combined with sensory hyperresponsiveness), and alternative not previously considered and a condition in which steroids are without apparent effect. This case illustrates the importance of a critical re-view of the diagnosis before high-dose corticosteroid treatment with its inevitable side effects is instituted.

The effect of a very-low-calorie diet with and without chronic exercise on thyroid and sex hormones, plasma proteins, oxygen uptake, insulin and c peptide concentrations in obese women.

In 18 obese women a very-low-calorie diet (VLCD) has been combined with exercise (three times a week = 1650 kcal/week; 6.9 MJ) and compared with the effects of diet alone. The adherence and tolerance of the diet was quite good. Oxygen uptake decreased significantly only in the exercising group. Sex hormones binding globulin increased while prealbumin and retinol binding protein decreased in both groups. Changes in T4, T3, rT3, TSH, TBG and insulin secretion appeared to be equal in both groups. No significant differences between the two groups have been found with respect to body weight, body fat and lean body mass loss. Glucose tolerance deteriorated in the diet only group but remained unchanged in the group combining diet and exercise. Insulin production after oral glucose load did not change in either of the two groups. A more pronounced decrease in c peptide concentration has been observed in exercising groups. Sex hormones binding globulin and testosterone concentration increased in both groups. No changes have been detected in the concentration of transcortin. It is concluded that during a short period of VLCD exercise did not produce a higher body weight loss nor a protective effect on lean body mass.