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IV worsening of the saturation

Dear team!
I am suffering from CF and I am 48 years old. Since I was 25, I do regularly about 2 times a year an iv-therapy. Unfortunately, it is often like this, that the lung function stays the same, however the oyxgen saturation is going to be worse and worse at the end. I have however not the impression to have too much mucus. However I have rather the feeling, that something in the body is not really well changed anymore. Blood cell count is super, everything's o.k. ...the physicians are of the opinion, it could be stucked secretions....After 3 to 4 weeks at home, the lung function stays the same and the saturation does not go under 93% during normal the end of the iv-therapy drops at least to 88%...I do not understand it...just had 2 times 3 million units of colistin and 3 times 4 g of tazobactam/piperacillin for the you know this phenomenon? Do you have some advice? Many thanks to the team!!
Dear CF patient,
that is a difficult question, that I cannot answer so easily either. As the iv-therapy obviously does not bring a clear improvement of the lung function, an improvement of the oxygen saturation can not be expected either. Why however, it is even decreasing at the end of the therapy, could have two possible reasons in my opinion.
One possibility is, that a type 4 allergy is developing over time that causes via an increased inflammation a worsening of the saturation.
More probable, however, is in my opinion, that via the iv-therapy parts of the lung are ventilated (that means there is less mucus there), that are however not optimally perfused, yet. Therefore there is a imbalance between perfusion and ventilation, that leads to a decrease of oxygen saturation especially during exercise. This imbalance will probably normalize sometime after the iv therapy and then the saturation is going to be better, again. Therefore the worsening is in the end not such a bad sign, however possibly a hint on the effect also in the "most far-off" areas.
Best regards,
Rainlad Fischer