Pulmonology Appointment today

[mshistory]

I had my appointment with the pulmonologist today regarding the asthma I suspected - the exercise test and spirometry tests both caused really bad coughing fits, so the pulmonologist said he's comfortable holding off on the methacholine challenge since my symptoms and response to albuterol are suggestive of asthma. I'll follow up with him in 3 months and we'll see how I do with just albuterol to manage attacks.

I have NEVER had problems like this before SjS...I've had the dry cough for years but the bronchospasms/asthma are new (since I've been diagnosed with SjS last year). I still don't know if there's a connection, but I suspect there must be...?

Thanks for all the advice in my prior post about asthma 

[irish]

THere is a connection between the sjogrens and the asthma. I was diagnosed with asthma back in 1981 or so. I had the choline challenge and it triggered coughing for me. The interesting thing is that I am an asthmatic who doesn't cough much. I get the bronchial spasms and tightness in my chest.

There is a relationship between the immune system and autoimmune disease and allergies, etc. They are all pretty much related and it is complicated big time. I am amazed at all the stuff these docs know about our body. I am speaking about the immunologists who specialize in the immune and autoimmune, allergies, etc.

It is good that you had a baseline exam by the pulmonary cause they have something to refer to now. Dryness in the lungs can often cause coughing also along with the thick secretions that get stuck in the bronchioles. I am surprised that the doc didn't put you on a steroid inhaler. These inhalers (containing prednisone or some other steroid) help to decrease the inflammation in the lungs which in turns decreases the swelling of the bronchioles. This helps to prevent coughing and it also helps you to cough up the thick mucus easier.

Try using a warm facial sauna to breathe in moist air and soothe the lungs. Irish

[anita]

Sounds like a good starting plan to control problems when it happens.  Keep track of the number of coughing fits to discuss with him at your next appt.  Based upon how many you're still having, he may try the steroid inhaler to help keep them from occurring to begin with.

BTW, my doc told me adult onset asthma is quite common with SjS.  I had the methocholine challenge and it caused the worst asthma attack I've ever had.  Glad you didn't have to do it for a diagnosis.

Keep us posted on your progress

[mshistory]

Thanks, Irish and anita! I figured there must be some connection with the SjS because I've never had this issue before. My pulmonologist seems to know a lot about the lung disease associated with SjS, but seemed surprised that all of my testing resulted in asthma not ILD like he suspected. He probably doesn't have many SjS patients.

I'm going to keep track of attacks, what I was doing at the time and how often I use the albuterol so we can figure out a game plan when I see him again.

I really hope we can avoid the methacholine challenge - just the spirometry test gave me such a bad coughing fit I was gagging!

Prednisone gives me a sunburn-like rash so I'm not sure I could use that on a daily basis, which is really aggravating because the best I've felt in a year was when I was given a medrol pack for bronchitis a few months ago - even with the burning rash, the rest of me felt so much better! But I was told I had to stop taking it  I've reacted to regular prednisone too. 

You've both given me such great advice on this, and I really appreciate it!

[irish]

There are many inhalers that might work better for you than the albuterol. These other inhalers are used daily to keep the bronchial spasms and coughing under control. The albuterol is then used for a rescue inhaler.

It may be that there is another steroid other than prednisone that can be given in an inhaler. I doubt if prednisone is even used in an inhaler. I was just using that as an example. There are so many different steroid combinations used for oral steroids and for inhalers. Probably would have to do some drug trials. Also, is it possible to have a skin test to check on your sensitivity to these steroid drugs. Good luck. Irish

[mshistory]

Oh, that's good to know! Thanks, Irish! I would like to be able to control this cough better rather than relying on albuterol all the time. I will talk to him about it at our follow up visit.