Autoimmune hepatitis and Asthma

[GrantInJapan]

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. The doctors diagnosed me at a top med university here in Japan with AIH again (No liver biopsy). 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.

Symptoms from AIH are almost none, but I do 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.

My questions 3:

1. The phrase asthma attack is often used.  I don't have attacks.  I have 24 hour a day asthma.  I would be dead in one day if my drugs were taken away.  This would be analagous to having a cold every day, but when you take certain drugs, the symptoms of the cold get better.  It doesn't mean the cold is gone and then returning.  Also, the more volume of food/water/anything, I could even eat rocks, I put in me the more asthma I get.  Pressure in my abdomen increases the symptoms.  I don't have reflux, since even water does this.  And my stomach is healthy, absent of symptoms anyway.  This question is:  Is this even asthma?  I cough up golf ball size white thick sputum after using the nebulizer.  If I exercise real hard and get real active, I can get rid of my asthma somewhat, but after quitting the exerices and cooling down it is a nightmare.  I think that is an adrenaline related issue.  I do know that adrenaline injections fix everything flat out cold, end of subject.

2. Is there anything I can do to make a serious dent in my asthma? Meptin, fulltide, theophylline, serevent all help, but I still carry my portable nebulizer and use it at 3 hour intervals.

3. AIH doesn't normally end up as asthma, at least from what I have read.  But my pericarditis, pneumonia, and polymyositis, oh, and inflammation of joints at different times and places (Big and red and painful) all seam part of this one big package.  Is my asthma just the result of the AIH, or should I start thinking about other cause of the asthma (Chlamydia pneumoniae, and mycoplasma), as is discussed by Dr. Hahn http://www.dean.org/researchers.

I will be in Seattle Washington for thanksgiving this year.  Should I get a blood panel and have it shipped to you?  I can do such.  Money is not an issue.

Grant

[PortiaElgin]

Looking for anyone who has had fulminant liver failure due to Halothane (a general anesthetic).

Anyone out there have drug induced liver failure?

Please E-mail me directly or here at "***@****"

Thank you kindly.

Judy

[Kevin Pho, MD]

To answer your questions:
1) The diagnosis of asthma certainly needs to be confirmed if you are still having symptoms despite the medications you are taking.  Pulmonary function tests or a methacholine challenge test are ways to make a more definitive diagnosis of asthma.

2) Again, making the diagnosis will be helpful to even confirm that asthma is present.  I would suggest a referral to a pulmonologist (lung specialist).

3) I am not aware of AIH being associated with asthma, although it certainly may be possible.  I would suggest finding a pulmonologist in the Seattle area and having a workup done for the shortness of breath.  In addition to the pulmonary function tests and/or methacholine challenge, you may want to consider imaging studies (i.e. a chest CT) to further evaluate the breathing symptoms.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[dartmouth03]

Hey Grant...

I'm a 24 year old male and I've had an elevation in my ALT that fluctuates for the past year..They did a liver biopsy and it showed mild nonspecific hepatitis (inflammation) and said it's possible that it could be an early form of AIH but they weren't sure b/c there was such a mild inflammation and no plasma cells present, as well as my gammaglobulins were normal and my ALT sometimes is also in the normal range, but then sometimes also bounces back up out of range...I just wanted to let you know that I live in Seattle and there are some pretty good doctors here if you want to get a second opinion.  I see one of the top hepatologists in Seattle at Virginia Mason Hospital downtown (1 of the top-30 gastro dept. in the US).  The heps name is Dr. Leonard Rosoff and the number there is 206-223-6600.  Seeing him while your up in Seattle might be of some help.  Good luck and if you have any questions drop me an email at ***@****  Take care.

Alex

[GrantInJapan]

Thanks for your kind help.  I called the number but I was too late today.  12 my time is 8 at night there.  I will call again tonight before sleeping.  I really do need to see a pro.  These doctors here run like computers.  They read the lab, and then dx, tx.  Nothing else.  By the way, I had my first hit of AIH when I was 24.  I ignored the doctors recommendations for prednisone and treatment.  It all went away on its own after 6 months and never returned until now.  Do your best to avoid the drugs if your doctor and you both feel you can.