Can Churg-Strauss be managed safely with COPD together?

Question

Hello doctor,

I have been struggling with severe asthma and chronic obstructive pulmonary disease for several years. Despite being on inhalers, nebulizer treatments, and steroid medications, I continue to experience frequent flare-ups and breathlessness that significantly affect my daily life.

Recently, I was diagnosed with Churg-Strauss Syndrome (also known as eosinophilic granulomatosis with polyangiitis), and I am feeling confused and overwhelmed about how this rare condition may be further impacting my lungs. I have read that it involves inflammation of the blood vessels and that it can worsen respiratory symptoms. However, I do not fully understand how it overlaps with my existing asthma and chronic obstructive pulmonary disease.

In addition to breathing difficulties, I am also experiencing unexplained skin rashes, numbness and tingling in my feet, and worsening sinus problems. Could these symptoms be related to the vasculitis caused by Churg-Strauss Syndrome?

I have also noticed that my oxygen levels drop quickly with even mild exertion, and this is very concerning. I am becoming increasingly worried about how much strain my lungs can take while managing all of these conditions together.

I would like to ask:

Is it still safe to continue my current medications for asthma and chronic obstructive pulmonary disease in the context of Churg-Strauss Syndrome?
Do any of these medications need to be adjusted or replaced to avoid worsening my lung function or systemic inflammation?
How can the inflammation from Churg-Strauss Syndrome be managed effectively without making my chronic obstructive pulmonary disease worse?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns. Churg-Strauss Syndrome now known as eosinophilic granulomatosis with polyangiitis (EGPA), can significantly affect the lungs, especially through asthma, eosinophilic pneumonia, and inflammation of blood vessels (vasculitis). This commonly leads to symptoms such as shortness of breath, coughing, and wheezing.

EGPA is closely associated with asthma and can sometimes be confused with chronic obstructive pulmonary disease due to overlapping respiratory symptoms. However, EGPA almost always occurs in individuals who have a history of asthma and is characterized by airway obstruction, eosinophilia (high levels of a type of white blood cell), and vasculitis (inflammation of blood vessels).

While asthma and chronic obstructive pulmonary disease may overlap in some individuals, a condition referred to as asthma-chronic obstructive pulmonary disease overlap (ACO), EGPA is a distinct systemic vasculitis that affects not only the lungs but also multiple other organs. These may include the skin, nerves (causing numbness, tingling, or weakness), heart, kidneys, and gastrointestinal system. The skin rashes, numbness in your feet, and worsening sinus symptoms that you mentioned are commonly associated with EGPA-related vasculitis.

Inhalers and nebulizer medications may need to be adjusted once EGPA is diagnosed, especially in individuals already using them for asthma or chronic obstructive pulmonary disease. This is because EGPA symptoms can sometimes worsen or become more apparent during changes in corticosteroid therapy, especially when reducing or stopping oral steroids.

Managing inflammation from EGPA requires a careful and individualized approach. Corticosteroids are usually the first-line treatment, as they help reduce inflammation and lower eosinophil levels. However, long-term use of corticosteroids carries potential side effects. Therefore, other medications such as immunosuppressive agents or biologic therapies may be needed, especially in more severe or widespread cases.

Close and ongoing monitoring by a healthcare professional is essential. Adjustments to your medications should be made carefully to manage the underlying vasculitis without worsening respiratory conditions such as asthma or chronic obstructive pulmonary disease.

That said, it is very important that you consult a pulmonologist in person. A detailed physical examination and comprehensive evaluation will help determine the most appropriate treatment plan for your combined condition.

I hope this information is helpful.

Regards.