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Respiratory Disorders  (Expert Forum)
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hypersensative pneumonitits??
Answered by
National Jewish -
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MedHelp Member's Question

hypersensative pneumonitits??

by missdiagnosed, Jan 13, 2006 12:00AM
hi, i am a 32 yr old female..now, non smoker..i have had a chronic cough now since august of 2005, which was then dx as allergies and bronchospasm, (i also have allergy induced asthma) I followed up with my dr because cough was real bad in morning,severe wheezing, ribs hurt from coughing fits during night. was then dx with GERD.i went back after 2 weeks for another follow up, and my lungs were almost closed, i was gasping for air in the office..WITHOUT a chest xray, i was dx with double pneumonia and put on AVALOX. i took the meds for 10 days, and did NOTHING. i told my dr i was now concerned that ive been misdiagnosed altogether, because my asthma meds no longer worked..they put me on biaxin and told me i had abnormal breath sounds, but still didnt order cxray. after a severe "asthma attack" i went to the ER .. they said..bronchospams again ..and put me on pred. which actually worked..but now my wheezing was permanent, no matter what drugs they used ..well, now its january..went to ER again because i couldnt breathe..and they FINALLY  said ..lets do a cat scan of lungs, and CXR. well, xray was negative, but the scan was not..I HAVE BEEN MISDIAG ALL ALONG, wasnt asthma...wasnt allergies, all my dr's are freaking out because apparently, i may have a hypersens to an allergy im overexposing my self to.. findings...abnormal study..demonstrating patchy areas of groundglass density in the upper lobes bilaterally..few small hilar and mediastinal nodes visible, mild emphysema present..dense calcification of the main pulm art.L+R branches..

IM TERRIFIED, IS THIS REVERSABLE?? HELP
Doctor's Answer

by National Jewish, Jan 31, 2006 12:00AM
Hypersensitivity pneumonitis (HP) is inflammation of the air sacs of the lungs.  This is caused by an allergic reaction to inhaled biologic dusts that are small, 5 microns or less in diameter.  Biologic dusts include animal or plant proteins, microorganisms, and rarely low-weight chemicals.



Usually the chest x-ray is abnormal with HP.  In the early stages of the disease the chest x-ray may be normal, while the high resolution CT scan is not.



The symptoms of HP include cough, wheezing, and/or shortness of breath, especially with activity.  Once exposure stops, the symptoms usually clear within a day.  Continued exposure can eventually cause permanent scarring of your lungs.  So it is important to find what is causing the symptoms.  Then you will know what to stay away from.  Inhaled steroids are used to decrease the inflammation before it becomes scarring.  Sometimes oral steroids, like prednisone, are needed.



Allergic bronchopulmonary aspergillosis (ABPA) is inflammation in the lungs.  This is an allergic reaction caused by inhaling a fungus called Aspergillus.  People with asthma are most likely to have this problem.  When inhaled steroids are not helping, then oral steroids are used.



You should ask your doctors how they would proceed to find the cause of your pulmonary artery calcification.  This is most unusual in a person your age.  It could lead to pulmonary hypertension.  You should definitely request a consult with a pulmonary specialist.  Whatever follows, you do need to have a thorough evaluation of these conditions.
Member Comments (6)

by missdiagnosed, Jan 13, 2006 12:00AM
i should add i smoked for 16 years, and ..also have numbness in left hand, which ive had now for 2 months, but told that was due to a pinched nerve, from coughing..

by J Johnson, Jan 15, 2006 12:00AM
was your CT done with contrast?

by missdiagnosed, Jan 15, 2006 12:00AM
yes, it was

by missdiagnosed, Jan 19, 2006 12:00AM
finally had my appt with my pulmonologist today ... my lungs sound clear, no wheezing, no crackling....off the prednisone.just taking pulmicort and foradil twice a day. i brought my IGUANA to a shelter (that is possibly what was causing the hypersensativity) and have felt great ever since, not one asthma attack. all the doc said was "come back in march for a follow up PFT and take it from there"  i really hope the damage done is not permanent. i quit smoking now for 11 days.. YAHOO!! my blood work is still pending for iguana ..so, time will tell if she was the problem.

by CINDY4, Jan 19, 2006 12:00AM
My daughter (she's 12 now, this started at 3) had the exact same experience as you. Seemed to be severe asthma, but it went on for 4 years with her before we found out what it was. Several recurrent episodes of "pneumonia". Treated with lots of steroids for the asthma. Which is ironically why it took so long to be diagnosed. Hypersensitive pneumonitis, can also be known as eosinophilic pneumonia. It can be a serious, life threatening disease without treatment, but now that it is diagnosed you will most likely be put on high dose steroids for a while, and very slowly weaned off (if possible)or onto a low maintanence dose. As my daughter's dr said when she was diagnosed, "it is the best bad lung disease you can have", because it is treatable, and many of these type diseases are uncurable, but this one can possibly go into permenant remission with early treatment. You got better when you went to the ER for the asthma because they started you on steroids, then as the steroids were tapered off it came back. This was the pattern we did for years with my daughter when we did not know what it was. She did steroids off and on for years, that is why it took so long to diagnose. As with you, the chest x-rays showed nothing, she had many of them over the years for pneumonia, but once a CT was finally done years later, it showed exactly what yours showed, the hazy, ground glass infiltrates, and enlarged lymph nodes. What these are is what inflammation looks like on CT. Many times with these diseases your eosinophil count in your blood will be high, because eosinophils are the blood cell that responds in allergic situations. These eosinophils fill your airways(they do in asthma too), but in this disease there is a whole lot more eosinophils in your airways than with asthma alone. Also these eosinophils cluster together and then spill out of the airway, and infiltrate into your lung tissue outside the airway. This lung tissue is called the interstitum. So your lung disease is considered an interstitial lung disease, because it is outside the airways too. Interstitial diseases are serious and that is why all your drs are freaking out. Many are uncurable, and not much can be done to stop the progression of disease. But with your disease being caused by the inflammation brought on by the eosinophils(the blood cell) you can treat it very effectively with steroids, and bring the eosinophils under control, and stop the damaging inflammation. You lungs