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Severe Asthma

Dr. Kagen:

I am a severe allergy induced asthmatic who has dealt with this for many years but have been out of control for the last three years.

35yo white female in general good health until three years ago when I experienced a severe asthma attack requiring high-dose IV push steroids to break. I have been steroid dependent since that time with maintenance being as high as 60-80mg per/day to keep airways open.

I have gained 100lbs. in the last three years due to the fluctuating doses of steroids. I am looking to shed some of this as I know it is not helping my respiratory status. The endocrinologist has suggested me trying the Atkin's diet and I have obtained the book but am somewhat hesitant as I have had several friends get ill from the diet by getting electrolytes out of whack.

Current Diagnoses include:
adrenal insufficiency (no function whatsoever in last 18 months)
ge reflux
osteoporosis
severe allergic asthma

Current Allergies:
asa, bcp's, betamethasone, benadryl, biaxin, demerol, motrin, norinyl-9, and topical steroids, dust mites, cockroaches, bermuda grass, and maple

Current meds and treatments:
ns spray bid
peak flow bid (usually 350-400)
o2 sats daily (95-98%)
glucometer readings qid (60-80mg/dl)
Miacalcin spray 2200iu/ml qd
Flovent 220mg 4 puffs bid
Claritin 10mg qd
MVI 1 tab qd
Prednisone varies but stable at this time on 15mg qam and 10mg qpm
aygestin 5mg qd days 1-12 of the month
Sudafed 12hr caplets bid
Humibid LA 1200mg bid
Pepcid 20mg bid
Os-cal 1500mg qd
Zyflo 600mg qid
Reglan 10mg qpm
Ventolin inhaler or aerosols q4hrs prn
Lasix 40mg prn fluid overload (use 1-2X/week)
atrovent .06% 3-4x/day prn rhinitis symptoms
Tylenol prn

These are my maintenance meds at this time. Usually require 21-28 days of antibiotics every 6 weeks for infections ranging from sinusitis to bronchitis. I have added yogurt to my diet daily to prevent thrush which I get frequently from all the antibiotic therapies. I pick up every germ that comes along which does not help as I am a nurse. Currently, in administration due to inability to work with my peds patients due to immunosuppression from the steroids. I wear a mask when outside which is infrequent as I can not breathe well in the heat of the summer, the pollenation of the spring and fall, and the cold of the winter sets off bronchospasms.

Needless to say, I am miserable and feel like I am trapped in my home. The home has been allergy-proofed to the point that I don't have knick-knacks or pictures. The bare essentials are in the home and we have Hepa'd everything possible.

I am very confident that my physician's here are treating me to the best of their ability but we are at a loss for where to turn next. The goal of all md's involved (family practice, urgent care, pulmonoligist, endocrinoligist, surgeon, OB/GYN, etc.) is to get me to the lowest dose necessary to maintain my pulmonary function without the side effects I currently experience.

The other side effect is the thinning og the skin. My skin is so terrible now that the stretch marks go from my neck to my ankles and the skin is so thin that you can actually see and manipulate the blood vessels under the skin as well as view the fascia of the next layer. I actually tear my skin in my groin when I sit and when lying down at night, the skin tears if it gets stuck to the sheets when I turn. I just want to be my old self.

I am open to any and all suggestions as is my pulmonologist at this point. He has encouraged me to use the internet to try to find alternative methods and will discuss them openly with me if we find something viable. I would appreciate a reponse, even if it is just to tell me good luck but you can't help.

Thank you,

Tina S.

Thanks for asking Tina about severe asthma.

You have described an unfortunate situation of being dammed if you do take steroids and dammed if you do not!

Do not underestimate the importance of gastro-esophageal reflux and possible hiatal hernia as it may be an integral cause of some patients' continued asthma symptoms. In some patients, a surgical repair of a significant hernia has resulted in the gradual decrease and elimination of steroid therapy for their asthma.

Atrovent is useful in patients with reflux, as it relaxes the lungs and allows for a greater inhalation in most cases of GE reflux.

Aspirin sensitive patients also commonly have sinus disease and polyps. The 'wet' sinus becomes infected, and patients with aspirin sensitivity and chronic sinusitis have persistent asthma until the sinuses are clean. If you are sensitive to aspirin products, then you must closely examine all of the pills and meds going into you to avoid all salicylates and other non-steroidal agents.

In my practice, I prefer the use of Accolate or Singulair over Zyflo as the former 2 drugs are easier to manage with no need to check the liver function blood tests.

The last thought regarding your situation is that you may be steroid resistant. This means that increasing doses of steroids like prednisone will not yield any significant benefits to asthma control, but may induce greater steroid side effects.

These ideas certainly must be reviewed with your excellent physicians managing your complex medical problems.

Good luck.

Steve Kagen, M.D.
Allernet.com