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Old 11-05-2007, 09:18 AM   #1
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mikeinfw HB User
Pneumonia and and Inhaled Corticosteroids

First, let me say that this post is simply an experience that hope to help others avoid. It has been among the most terrible experiences in my life.

Summary:

If you have an respiratory infection and your doctor gives you both antibiotics and a steroid inhaler (Prednisone, Symbicort, budesonide, etc.) be VERY CAUTIOUS about taking it.

Background:

I am a middle aged male in very good health. I maintain a very good diet, exercise regularly, get adequate sleep. I don't smoke, don't drink, and do everything I can to take care of myself.

Disclaimer:

What I describe here is a THEORY ONLY. It is has not been medically or scientifically verified, so I may be completely wrong. Nevertheless, based on the research I have done along with the symptoms, I feel strongly enough about it to post it here. As always, you need to use your judgment and consider all the facts carefully for yourself. I only present this information so that you can at least be aware of the possibilities.

Story:

I was diagnosed with bacterial pneumonia last Thursday in the ER. I don't know what kind of bacteria, but I suspect mycoplasma. However, pneumonia is not what led me to the ER. Earlier that evening, after returning home trick-or-treating with my kids, I had a single cough drop, the sugar from which caused me to go into hypoglycemic distress. I did not know at the time what was happening. It was extremely frightening, and I thought I was going to die.

Here's what happened (the theory). Three days earlier (Monday) I went to my doctor because of the lower respiratory infection that had persisted for two or three weeks (no fever or chills). He listened to me, said my airways were very constricted, gave me a breathing treatment and measured my long capacity (before and after). He could not decide whether it was asthma (I've never had asthma), or an infection. So, he gave me Zithromax and told me to inhale Symbicort twice a day. Foolishly, I did not read all the contraindications to Symbicort and just followed orders.

I took it that night, twice Tuesday, and once Wednesday. That night is when I had the episode.

What happened? Well, it took some time and a lot of research to find out. I noticed Thursday morning after breakfast that I became very weak, just like the night before, although not quite as bad. I had waffles (and light syrup fortunately). This continued to happen after every meal. The degree to which it occurred seemed to be related to the amount of simple carbs I ingested.

This pointed to something glucose related. I followed glucose to insulin to glucagon (or lack thereof) to hypoglcemia to adrenal unsufficency to inhaled corticosteriods. One of the side effects (which most often listed as rare) on inhaled corticosteroids is adrenal insufficiency. In fact, there have been numerous studies on fluconazole and adrenal insufficiency (just Google it).

However, many of the studies show that it is prolonged use of these inhalers that lead to HPA axis disruption (resulting in adrenal insufficiency). Not necessarily acute exposure. However there are a few things to consider. Inhaled corticosteriods have a much greater variance in how much is delivered. Actual dosage delivery ranges widely based on lung capacity, how even dispersed the mist is, etc.

But, I am not making a case for blaming all of this on the Symbicort. I think it was both the combination of the Symbicort AND the infection that led to my adrenal crisis. The infection had wearing down my immune system for weeks. My adrenals where already at their limit. The Symbicort was the proverbial straw. It led to the final HPA axis disruption that threw my whole system out of balance.

So here is what happened: I take the cough drop, sugar enters my blood stream. My pancreas responds with insulin. The insulin sends the sugar into cells, the sugar leaves the blood, but there is still excess insulin that needs to be taken care of. This is the job of the HPA axis (hypothalamus, pituitary, adrenal). What should happen now is the pituitary detects the excess insulin, sends a message to the pituitary, which then signals the adrenals to secrete cortisol, which leads to glucagon release which neutralizes the insulin.

In my case, everything worked except for the adrenals. They were shot. The net effect: insulin runs amuck, continues pushing sugar out of blood into cells, blood sugar takes a nose dive, bam -- hypoglycemic distress. The only thing you can hope for then is your liver to bail you out in time, which is not an instantaneous process. Had I eaten some Halloween candy as well, I could have been in real trouble.

I know all of this may sound complicated. Trust me, I only had a rudimentary understanding of the process until I was forced to revisit in detail (because of fear of death). But I think it is a very real possibility that can be life threatening.

Here is what I want to conclude with:

1. (IN MY OPINION) If you have an infection, don't take steroid inhalers. Besides the above problems, steroids suppress your immune response. Steroid inhalers are important if you could die from an asthma attack. That is, there potential side-effects are acceptable only when death the alternative.

2. Long infections like mycoplasma and pneumonia in general also cause great stress to your adrenal glands. You can run into trouble just from the infection. When you combine this with steroids, you may have seriously compounded your trouble.

3. One thing I found that helped me considerably what vitamin C and B complex (esp. Vitamin C). Lots of it. However, that's all I will say. I'm not going to risk being demonized here by reigniting the vitamin C debate.

4. There are studies that indicate that my theory on cortocosteroids is wrong:
[url]http://www.bmj.com/cgi/content/full/329/7462/0-f[/url].

Again, I am not trying to preach, or come to any absolute conclusion. I'm not saying I am 100% correct. In fact, I am completely aware of the possibility that I could be COMPLETELY INCORRECT in my assessment.

All I know is something very serious happened to me, and I think these are the primary contributing causes. Do your homework before taking inhaled steroids of any kind, and be especially cautious about it if you have an infection. I am only posting it here as something for you to consider and be aware of.

I think I am through the worst now, but have a way to go. I hope this never happens to me again.

 
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Old 11-17-2007, 07:20 PM   #2
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lailavia HB User
Re: Pneumonia and and Inhaled Corticosteroids

Wow that is quite interesting as I ahaving a problem related to adrenals and steroid use. I had 3 epidural steroid shots in spine for pain issues in June/July and right after that I JUST HAPPENed to have an ACTH cortisol stimulation test after trying for years to figure out some causes of some health problems.

Anyway I wish I had a test before the shots, I will never know now , but I had virtually no adrenal function. I was put on cortef tablets and it has been 3, almost 4 months! I am due for another ACTH test this week, have had several , to see if anything is better. I have begged to get off the coritisone as it it making me insane, and I am down to 10 mgs from 30 a day, I am going to start weaning off of it after the test . I cannot live like this. I may have to find a natural help. The last ACTH stim test showed very slight improvement, but how can my adrenals get better if they are not working? She keeps saying I will get deathly ill if I get sick (and am not on the cortef) and I have not been sick once, just the normal CFS and fibro pains....I am so depressed and I don't want a humpback. And they told me i could take symbiocort!!!!!!! I was rxd a sample by my copd doc who also acted like it was nothing to worry about. Well I didn't like it anyway and was just switced to asmanax, which also has steroid, and I am totally confused about all of this. I have to force myself out of bed each day.....once up I feel better but still mad, angry and not myself. I am not to have steroid injections anymore, but they are all saying the inhaler is ok. I think my cortisol was low from a blood test last February, it was 3.5 they seem to ignore that. I have had so many problems with doctors it is not funny. they must be so overworked they just miss important details or don't put things together. I have several odd health problems that I am stilll working on getting answers, it just amazes me how this can be going on. My endo doc said it could take 6 months for my adrenals to recover...like I said I think mine were shot before the shots....but I may have to go find a 2nd opinion on this whole mess. Now I am worried about the inhaler. I have a bad cough in the morning and am being checked for some lung diseases, the doc finally ordered a CT....there is tooo much to go into but apparently it is rare but steroid use can cause adrenal suppression , if it was just from a few puffs of that inhaler, you may have something going on already, I would try to get a full work up....I have had all kinds of tests, and they can't find anything so are still "assuming" it is from shots..it sounds like you are having or had a full blown addisonian crisis...have you been to docs about that? Your body may be very low on cortisol and I would go get checked asap...google Addisonian crisis you will see what I mean.you could die, if that happens again and you are not injected with emergency cortisone I am not trying to scare you but that is some stufff I learned after my fun experiences this summer........let me know what happens!

Last edited by lailavia; 11-17-2007 at 07:29 PM.

 
Old 11-17-2007, 07:36 PM   #3
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lailavia HB User
Re: Pneumonia and and Inhaled Corticosteroids

oh hi again, one more thing I just thought of, and I too could be wrong on alot of this stuff, but just trying to help a little, maybe the fact that you were sick, like you said, had your adrenals run down, but maybe they were ALREADY run down and that is why a few puffs of the inhaler made things worse, plus having the infection. my doc said to double my dose if got sick and if I felt dizzy, weak or nauseaus I may need IV med.....none of that has happened except I just feel lousyfrom the cortisone!!! Some people on my fibro forum use it to help themselves but I hate it.

 
Old 11-29-2007, 09:24 AM   #4
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mikeinfw HB User
Re: Pneumonia and and Inhaled Corticosteroids : SOLVED

lailavia, thanks for your replies. I've been away for a while so I've not been able to respond until now.

Well, I owe it to those who read this post a follow up. It was NOT the Symbicort (glucosteroids). I went to an internist and along with the help of an ENT friend of mine, finally figured out what it was -- Labyrinthitis.

While it was possible to explain my symptoms as a result of adrenal crisis, my internist was able to rule it out via use of a glucometer. The following week I measured my glucose at regular times, and when I would have an episode. It was always normal. Never low. Yet I was clearly having some kind of crisis that felt like the equivalent of hypoglycemia.

Well the crisis was the result of adrenaline, resulting from a panic attack (never had them before in my life, didn't even know such a thing existed), brought on by vertigo (never had that either). Vertigo was the one variable common to all situations. I didn't realize it's importance. But it is common after pneumonia, and it is one of the chief causes of panic attacks. Part of the problem is that you don't realize that you have vertigo, you just have an overpowering sensation that you've lost control and that something really bad is happening, but you don't know what. I wasn't even fully aware that I was dizzy, I kind of instinctively thought the dizziness was a result of something else happening.

My initial bout of vertigo was really bad, making me feel like I was falling at 100 mph, which caused the adrenaline rush, which then caused all the crazy side effects. The problem with panic attacks is that they can turn into uncontrolled feedback loops. Thus the more I panicked, the worse it got.

After a week of sheer hell trying to figure out what was happening, I called my ENT friend as a last resort. He was sure it was Labyrinthitis. He told me that the next time I got vertigo, to recognize it. Sit down if I had to, but to simply be aware of it, and by doing so I could begin to prevent the panic attack. If that didn't work, then take a Xanax. By that time, I think I had almost conditioned myself to have a panic attack at the onset of vertigo, but it worked. After a day or so of mentally fighting with it, I could just recognize the vertigo and keep it at that -- vertigo. No panic attack. It's starting to get better, but I still have bouts. He said it can last up to six weeks (and in some cases longer or even indefinitely). But I don't at all mind the vertigo now compared to what I dealt with before. I have a whole new appreciation for people who suffer from diabetes, Addison's, or general adrenal insufficiency. My heart goes out to you.

Anyway, I am posting this to make it clear that my initial hypothesis was wrong, and this is what really happened. I will say this, vertigo is downright evil. I never, never, would have imagined that it can provoke such a drastic and frightening response. It can. It is one of the most frightening things I've ever experienced. But you can control the monster once you've identified it. I just wish I would have known this the first time it happened -- would have avoided a lot of doctor visits and tests.

 
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