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Respiratory Disorders (Expert Forum)
Adult onset asthma, related to Autoimmune hepatitis? Treatment?
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Adult onset asthma, related to Autoimmune hepatitis? Treatment?
by GrantInJapan, Nov 12, 2004 12:00AM
I had a short brief with AIH when I was 23. I never got treatment. It went away. Then about 3 years back, at age 41 for no reason I got pericarditis, followed by Pneumonia, then polymyositis, and finally asthma. I have no previous mediacal on any of these. I eat good, exercise, stay slim, and am chiropractor, so always followed the healthy road. I am currently taking 10mg. prednisone daily.
I actually only have one real big problem. Since this all started I have had severe asthma. I mean real severe. I have to take a portable nebulizer with me whereever I go. I use a bottle of meptin once a month 30ml. I take fulltide, 800mcgdaily, serevent 200mcg daily, and 800theophyline daily. If I don't move I can almost not have asthma, but as soon as I move, meaning walking etc, it returns.
My questions 3:
1. The doctors here in Japan tell me Asthma has nothing to do with AIH. I never had it at all before the AIH. I think they are related. Is there a referrence showing such?
2. Is there anything I can do to make a serious dent in my asthma? I have had IV's of amynophalene (SPelling?)and when I up my oral steroids or mega dose on the fulltied I do good. But that seems to be a bit hard in the long run on my body isnt it? Would weekly amynophyline IV'S be a good idea?
3. Since I am male, normally quite healthy, this seems a bit weird to get this disease. Is it possible there is some new or different approach that would be worth trying, for example the 3 month zythromax at 750mg per week program recommended by Dr. Hahn http://www.dean.org/researchers
I actually only have one real big problem. Since this all started I have had severe asthma. I mean real severe. I have to take a portable nebulizer with me whereever I go. I use a bottle of meptin once a month 30ml. I take fulltide, 800mcgdaily, serevent 200mcg daily, and 800theophyline daily. If I don't move I can almost not have asthma, but as soon as I move, meaning walking etc, it returns.
My questions 3:
1. The doctors here in Japan tell me Asthma has nothing to do with AIH. I never had it at all before the AIH. I think they are related. Is there a referrence showing such?
2. Is there anything I can do to make a serious dent in my asthma? I have had IV's of amynophalene (SPelling?)and when I up my oral steroids or mega dose on the fulltied I do good. But that seems to be a bit hard in the long run on my body isnt it? Would weekly amynophyline IV'S be a good idea?
3. Since I am male, normally quite healthy, this seems a bit weird to get this disease. Is it possible there is some new or different approach that would be worth trying, for example the 3 month zythromax at 750mg per week program recommended by Dr. Hahn http://www.dean.org/researchers
Doctor's Answer
by National Jewish, Nov 23, 2004 12:00AM
, Nov 23, 2004 12:00AM
First, I know of no relationship between autoimmune hepatitis (AIH) and asthma. However there have been case reports of an association between polymyositis and hepatitis B virus infection.
With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs. This inflammation is decreased and prevented when an inhaled steroid is used daily. Bronchospasm is the tightening of the smooth muscles that surround the airways of the lungs. A fast-acting inhaled bronchodilator medicine, like albuterol by nebulizer, reverses the bronchospasm quickly by relaxing the smooth muscles.
It is most important that the inflammation and your asthma be under good control. When this inflammation is not controlled, it increases the sensitivity of the airways to a variety of things that make asthma worse. These asthma triggers vary from person to person. If you need to use a fast-acting inhaled bronchodilator medicine more than twice in a week this means that the inflammation and your asthma are not controlled. Your doctor may recommend taking a higher dose of the inhaled steroid. There is much less risk of side effects from an inhaled steroid, so this is a good option instead of taking more oral steroids. In the long run oral steroids are harder on your body than inhaled steroids. Asthma that is not controlled is harder on your body than using a higher dose of an inhaled steroid. Finally, a weekly infusion of aminophylline would not be a good idea.
Please read the information on the National Jewish Medical and Research Center’s website at http://asthma.nationaljewish.org/ for more information about asthma.
With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs. This inflammation is decreased and prevented when an inhaled steroid is used daily. Bronchospasm is the tightening of the smooth muscles that surround the airways of the lungs. A fast-acting inhaled bronchodilator medicine, like albuterol by nebulizer, reverses the bronchospasm quickly by relaxing the smooth muscles.
It is most important that the inflammation and your asthma be under good control. When this inflammation is not controlled, it increases the sensitivity of the airways to a variety of things that make asthma worse. These asthma triggers vary from person to person. If you need to use a fast-acting inhaled bronchodilator medicine more than twice in a week this means that the inflammation and your asthma are not controlled. Your doctor may recommend taking a higher dose of the inhaled steroid. There is much less risk of side effects from an inhaled steroid, so this is a good option instead of taking more oral steroids. In the long run oral steroids are harder on your body than inhaled steroids. Asthma that is not controlled is harder on your body than using a higher dose of an inhaled steroid. Finally, a weekly infusion of aminophylline would not be a good idea.
Please read the information on the National Jewish Medical and Research Center’s website at http://asthma.nationaljewish.org/ for more information about asthma.
1: Int Arch Allergy Immunol. 2003 Nov;132(3):210-4.
Asthma as a paradigm for autoimmune disease.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14646381&dopt=Abstract
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2. Weekly aminophylline IVs; no I don't think so. You are already taking 800 mg theophylline/day, which is the same drug. This is a relatively high dose. This drug has a narrow therapeutic range.
Best way to control is using an Action Plan to monitor your asthma with a peak flow meter; increase inhaled steroid when peak flow drops below 80% of normal and use bronchodilator as needed. Add oral steroid at 50% of normal; or whatever plan you work out with your doctor.
Have you taken steps to control any environmental factors.
Also both postnasal drip from rhinitis/sinusitis and GE reflux,
can trigger asthma.
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3 You could make a trip to a top lung hospital for a full evaluation; like Nat Jewish in Denver. Maybe you have an asthma look alike lung disease.
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Regarding: Have you taken steps to control any environmental factors?
I dont really know where to start with this, because there is nothing that triggers my asthma. I have it 24 hours a day. People use the phrase asthma attack. I don't have such. I am 100% under constant asthma. I take drugs and it gets better. When the drug wheres off it returns. My asthma is not an on/off sort of thing. If it were such, I would try and see what "triggers" it. As best as I can tell "breathing" is what triggers it.
Regarding: Also both postnasal drip from rhinitis/sinusitis and GE reflux,can trigger asthma.
I do know that after eating my asthma will get worse in accordance with the volume of food. It seems to me it is some sort of an internal pressure related thing. I could just drink a large volume of water and it will get worse.
And lastly, I believe 100% I do have an asthma look alike problem. People talk about asthma like it is something they have and then don't have. I never "don't have asthma". I just get less asthma when I take drugs.
Thank you for your kind help.
Grant
I am a female, 43, living in Ontario, Canada. I survived Toxic Hepatitis from Halothane and pericardial effusions as a complication of the liver failure.
God Bless.
Judy