How long before Prednisone has effect on sarcoidosis?

[gerry57]

I have an uncertain diagnosis. Biopsy during cancer diagnosis in 2007 found sarcoids in lungs. Had never had a problem with them at that point, but now having pretty severe problems with shortness of breath after mild exertion, chronic dry cough, wheezing (I practically sound like a pipe organ sometimes), tightness in chest, trouble breathing while lying down, and dizziness and occasional brief headache when I stand up. Also have volitional tremors, but they may be a holdover from cancer treatment.

Pulmonologist has eliminated asthma, but says PET and CT scans (done recently for cancer followup) don't show enough sarcoids to account for symptoms. Next step is getting scoped, but before that he wanted to see if Prednisone would help. He prescribed one week at 40 mg/day, another at 30 mg, and a third week at 20 mg.

My main question at the moment is: How quickly should I expect the Prednisone to provide some relief from symptoms, if ever? I'm four days into the first week and feeling no better--maybe even worse. Sleeping is getting to be a real problem because I get so short of breath. If 40 mg have no effect, will 30 or 20 mg?

Second question: If neither asthma nor sarcoidosis, what else could it be?

I'm 51, by the way. Never been a smoker and no major exposure to airborne contaminants. Cancer treatment (chemo, radiation, surgery) ended 06/08. Cancer was in both tonsils. I'm in remission.

[National Jewish Health]

Recurrent/chronic sinusitis can be very distressing for both child and parent.  The following describes normal sinus development.
Both the ethmoidal and maxillary sinuses are present at birth, but only the ethmoidal sinuses are pneumatized or air-containing.  The maxillary sinuses are not pneumatized until 4 years of age.  The sphenoidal sinuses are present by 5 years of age, whereas the frontal sinuses begin development at age 7 or 8 years and are not completely developed until adolescence.  The ostia draining the sinuses are narrow, about 1 to 3 mm, and drain into the ostiomeatal complex in the middle meatus.  The paranasal sinuses are normally sterile, maintained by the mucociliary clearance system.

In some instances chronic sinusitis, both in children and adults, is the result of a deficiency in some of the immunoglobulins that normally act to prevent such infection.  The 2 most common of these are:  1) IgA deficiency; and 2) common variable immunodeficiency.  IgA deficiency is defined as serum IgA levels lower than 7 mg/dL and this deficiency is associated with both sinus and lung infections.

While these conditions are relatively uncommon, they should be considered in the child with, otherwise unexplained, recurrent sinus infections.  Imaging of the sinuses with either magnetic resonance imaging (MRI) or CT scanning might, for example, reveal a congenital, anatomical abnormality of one or more sinuses that, with impaired drainage, could predispose to infection.

You might also consider requesting a second opinion from a pediatric ENT or infectious disease specialist, perhaps at the local children’s hospital.

Good luck.