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

Question

Hi doctor,

For 7 years, I was affected by chronic hypersensitivity pneumonitis (HP). From that time, I have been on oxygen therapy and steroids 4 mg. My doctor told me to taper them and stop, so as per his advice, I slowly tapered the dose of steroids and finally stopped. When I stopped it, I was not able to move or walk, and my saturation at rest fell to 75% without an oxygen concentrator. But it rises to 99% on an oxygen concentrator.

If I am on steroids, then my oxygen at rest is 90% or above, and I am able to walk freely. I failed so many times when I tried to stop steroids. What is the relation between steroids and oxygen saturation? Why am I not able to walk without steroids? When I asked my doctor about this, he did not believe me and said it was a withdrawal symptom of steroids. I know about the adrenal insufficiency problem, but what is the reason for the lowering of saturation and being unable to walk?

Please explain.

Answer 1

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 a tapering dose, but still, you are not able to stop them 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, it is still 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 to talk to your pulmonologist about 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 further diagnosis is confirmed. So, a detailed discussion with your pulmonologist will guide you further. At last, I advise you to be patient, as it is a lifelong disease, and a perfect diagnosis is a must before starting any new medicines.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The previous biopsy was done more than two years ago. It is very important to repeat the computed tomography (CT) scan and lung biopsy now for the 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. A detailed study of previous and current CT scans and biopsies is a must for a conclusion. By the time, my suggestion is that you need to continue the same dose of steroid.

I hope this helps.

Thank you.