Pneumonias

Question

Dear expert,

I suffer from severe asthma which has proven to be almost completely resistant to therapy. The only thing that brings relief are high oral dosages of cortisone. Lung function is permanently limited. I have about three pneumonias per year in addition to several other infections. One could almost speak of a “long-term antibiotics therapy.” There has been repeated evidence of Pseudomonas in my sputum. I have often been given Ciprofloxacin during the infections, but also i.v. antibiotics.

The lung specialists in the lung clinic think that this is most likely a chronic colonization. Does this mean that one keeps the bacteria in the lung forever? And are they responsible for the infections?

Last week I did a sweat test and came out at 50. This means it is inconclusive, right? Could the test be wrong? I am 20 years old and CF is usually not diagnosed at that age after all, is it? Can one have severe asthma (I often end up in the hospital due to attacks) and CF? Is there a big difference at all in my case? My asthma is progressing and lung function deteriorates from each series of infections to the next. I regularly inhale salbutamol via Pariboy®, since I have severe shortness of breath and can get rid of the sputum more easily this way. I am particularly tight in the mornings. Therefore, my everyday life is characterized by inhalation and breathing therapy anyway.

I was suggested to inhale antibiotics permanently and to see whether the frequency of infections, particularly of pneumonias, would decline with that. Which of the two is more harmful – oral antibiotics every four to six weeks or long-term anbitiotics inhalation?

The doctors think the progression of my asthma is unusually severe. Over the past four years, my lung function has deteriorated rapidly due to the pneumonias.

Kind regards.

Answer

Hello,

many questions about a long history of your disease.

Let me start with the question on CF and the sweat test: A sweat test of 50 (chloride, I presume) is just on the borderline and should be repeated. CF is often diagnosed in adults and even later than age 20 – often with milder progressions, of course. Several of your symptoms would definitely be consistent with CF and one can indeed have CF and asthma or asthma-like symptoms at the same time.

At any rate, the diagnosis should be made or ruled out. If there is an underlying CF, one would additionally use several other drugs and certainly also recommend inhalation therapy, which you mention. For this reason, it is necessary to ensure the diagnosis so that you can be given medications that can only be prescribed for CF.

About chronic colonization: this means that the bacteria are always in the lungs – sometimes more so, sometimes less – and cannot be removed. This is a typical phenomenon with CF and sometimes with other lung diseases as well, though rarely with asthma. Therefore, the reason for your colonization should be checked thoroughly. Perhaps it would also make sense to present to an adult CF clinic.

I hope this helps.

Kind regards

Prof. Dr. Joachim Bargon

23.06.2010