On reducing steroid dose, why does my oxygen saturation level go down?

Hello,

Welcome to icliniq.com. Hypersensitivity pneumonitis or HP is a type of interstitial lung disease. It is a chronic type of lung disease and treatment usually runs longer, especially with steroids and immunosuppressive drugs. As you said, you are taking steroids in tapering dose but still you are not able to stop it completely. So, there can be two possibilities. One is a recurrence of the underlying disease and the second is the possibility of another disease like lung fibrosis. Though you are taking steroids chronically, still it is inadequate if you are suffering from lung fibrosis. After going through your computed tomography (CT) scan report (attachment removed to protect patient identity), there are areas of lung distortion and honeycombing. This finding goes in favor of lung fibrosis. If it is so, then I advise you talk to your pulmonologist for the possibility of IPF (idiopathic pulmonary fibrosis). Treatment can be optimized accordingly. As you said, you are dependent on oxygen and steroids; you need to continue till the further diagnosis is confirmed. So, detailed discussion with your pulmonologist will guide you further. At last, I advise you to keep patience as it is a lifelong disease and perfect diagnosis is must before starting any new medicines. All the best and take care.

Hello,

Welcome back to icliniq.com. The previous biopsy is done before two years. It is very important to repeat computed tomography (CT) scan and lung biopsy now for current status. As you said, lowering steroids causes desaturation; it suggests either chronic hypersensitivity pneumonitis or some fibrosing condition that needs further treatment. Repeat the lung biopsy, which will clear the picture and guide further treatment. It is obvious that lowering the steroids will cause worsening of the underlying disease, which causes desaturation. Detailed study of previous and current CT scan and biopsy is must for conclusion. By the time, my suggestion is you need to continue the same dose of steroid.