Breathing Issues
 

About six or seven weeks ago I had a significant case of bronchitis. Treated with antibiotics and prednisone.

Cough finally cleared up, but now I am experiencing shortness of breath. Don't know if this is lingering from bronchitis--it seems to have gotten more significant in the last few days.

Short breath happens with very little exertion. No wheezing, no coughing, don't really feel tight in chest.

Of course my mind immediately goes to lung mets. Anybody have any experience with this type of symptom?

We are always just trying to stay sane, aren't we?

Re: Breathing Issues
 

are you still taking meds for the bronchitis? Maybe a med reaction? Seems unlikely for lung mets to get to breath hindering levels without being detected.

Re: Breathing Issues
 

Re: Breathing Issues
 

Ah yes Pink, the great garage door incident!

Maybe I won't drive for a few days...........

Re: Breathing Issues
 

Rhonda...I am guessing inflammation from the bronchitis, maybe an inhaler would take care of it...the time I had the shortness of breath it was due to fluid around my heart, and I blame that on the chemo I was on....better to get it checked than worry, but it sounds like remnants of the bronchitis.

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I like the inflammation theory. I hope recalling the great garage door incident didn't exacerbate the shortness of breath-it certainly made me laugh out loud. Let us know how it goes, Trish

Re: Breathing Issues
 

Rhonda,

How has the humidity been in the great state of Tennessee? I only inquire because when humidity is present those with lung disease have an increased difficulty breathing. Your lungs are very likely recovering from the wicked bronchitis. I suggest if it is humid to remain in the AC as much as possible. I also suggest a cool beer whenever possible, but I digress.....

Re: Breathing Issues
 

Rhonda,

Not sure if the link below will help or make your condition worse. Remember how medical students are prone to thinking they have the illnesses that are discussed in class. :)

http://familydoctor.org/online/famdo...mptom/521.html

Re: Breathing Issues
 

How's the breathing issue, Rhonda? Improved?

Re: Breathing Issues
 

Better thanks, but still bothersome. Got an inhaler, trying to stay out of the hot, humid, pollen filled air. I guess it will just take some time.

Re: Breathing Issues
 

I would ask for a chest xray. If it is lingering bronchitis or if you have developed pnemonia it should show up on the xray. It might show up as a shadow if something more serious has developed.
Take good care of yourself. Hang in there.

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Not mets - I'm with Rich on that. (Garage door - HA! Let's not forget my new Michael Kors purse to hold all my NEW pre-meds!)

Re: Breathing Issues
 

Hi Sassy,
If you still have some SOB I would go have it checked out to be on the safe side--and for pure peace of mind. I agree with Elaine...at least go get a chest X-ray. When it doubt...check it out is my motto. HA.

Plus I just know you will worry yourself sick about it--because we all do when we have a new symptom. The mind always goes "there". I just hate that. But it sure is nice when you find out it's nothing serious. :) (Maybe your just noticing your breathing more since you were taken off the prednisone?) Just a thought? Let us know if it improves over the weekend?

Chelee

Re: Breathing Issues
 

those on herceptin (are you still?) may have a more prolonged period of recovery from inflammation/infection of the upper airways and perhaps some lower ones.

I posted several times here the case of a woman who developed a chronic cough on herceptin which resolved once she stopped herceptin. She agreed to have biopsies done both during AND AFTER her coughing which was attributed to the herceptin.

I used the search function and put in cough herceptin Lani and came up with three times I had posted on the topic since 2007. Here is one:

For those complaining of nasal/sinus symptoms/coughing which they relate to Herceptin, I submit the following two articles. The nose, like the more distant airways/bronchiols have ciliated epithelial cells (lining cells with tiny hairs which help trap bacteria, molds and other particulates) . These articles raise questions which may help explain symptoms while on Herceptin--showing that her2 is necessary not just in embryogenesis, but also in adulthood for repair of these kinds of cells. They may help explain your nasal complaints, the reports of rare pulmonary problems in patients on Herceptin and perhaps the dry-eye problem I posted on before. The more they look into what her2 does, the more they find!:


Am J Physiol Lung Cell Mol Physiol. 2006 Feb 17; [Epub ahead of print]
Related Articles, Links
*
Differentiation of Human Airway Epithelia Is Dependent on ErbB2.

Vermeer PD, Panko L, Karp P, Lee JH, Zabner J.

Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.

A clinical case documented a reversible change in airway epithelial differentiation that coincided with the initiation and discontinuation of trastuzumab, an anti-erbB2 antibody. This prompted the investigation into whether blocking the erbB2 receptor alters differentiation of the airway epithelium. If so, blocking or exogenously stimulating the receptor would lead to consequences on differentiation. To test this hypothesis, an in vitro model of well-differentiated human airway epithelia was treated with trastuzumab or heregulin-alpha, an erbB ligand. In addition, co-culturing with human lung fibroblasts tested whether in vivo subepithelial fibroblasts function as an endogenous source of ligands able to activate erbB receptors expressed by the overlying epithelial cells. Epithelia were stained with hematoxylin and eosin and used for morphometric analysis. Trastuzumab treatment decreased the ciliated cell number by 49% and increased the metaplastic, flat cell number by 640%. Heregulin-alpha treatment increased epithelial height, decreased the number of metaplastic and non-ciliated columnar cells while it increased the goblet cell number. We found that normal human lung fibroblasts express transforming growth factor-alpha, heparin binding-epidermal-like growth factor, epiregulin, heregulin-alpha, and amphiregulin, all of which are erbB ligands. Co-cultures of airway epithelia with primary fibroblasts increased epithelial height comparable to that achieved following heregulin-alpha treatment. These data show that erbB2 stimulation is required for maintaining epithelial differentiation. Furthermore, the mesenchyme underlying the airway epithelium secretes a variety of erbB ligands that might direct various pathways of epithelial differentiation.

PMID: 16489114 [PubMed - as supplied by publisher]


1: FASEB J. 2005 Aug;19(10):1374-6. Epub 2005 May 27.
Related Articles, Links
*
ErbB2 activity is required for airway epithelial repair following neutrophil elastase exposure.

Fischer BM, Cuellar JG, Byrd AS, Rice AB, Bonner JC, Martin LD, Voynow JA.

Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.

In cystic fibrosis and chronic bronchitis, airways are chronically injured by exposure to neutrophil elastase (NE). We sought to identify factors required for epithelial repair following NE exposure. Normal human bronchial epithelial cells were treated with NE (50 nM, 22 h) or control vehicle. Following NE treatment, we found a marked and sustained decrease in epithelial proliferation as detected by Ki67 immunostaining. 3H-thymidine incorporation was also initially depressed but increased over 72 h in NE-treated cells, which suggests that DNA synthesis constitutes an early repair process following NE exposure. We hypothesized that ErbB2 receptor tyrosine kinase, a regulator of cancer cell proliferation, was required for epithelial DNA synthesis following NE exposure. Immediately following NE treatment, by flow cytometry analysis, we found a decrease in ErbB2 surface expression. Protein levels of the full-length 185 kD ErbB2 receptor significantly decreased following NE treatment and smaller ErbB2-positive bands, ranging in size from 23 to 40 kD, appeared, which suggests that NE caused ErbB2 degradation. By real-time RT-PCR analysis, we found no change in ErbB2 mRNA expression following NE treatment, which suggests that changes in ErbB2 protein levels were regulated at the post-translational level. Following NE treatment, full-length 185 kD ErbB2 levels increased to pretreatment levels, correlating with the increase in thymidine incorporation during the same time period. Importantly, inhibition of ErbB2 activity with AG825 (5 microM) or Herceptin (3.1 microM), an ErbB2-neutralizing antibody, blocked thymidine incorporation only in NE-treated cells. These results suggest ErbB2 is a critical factor for epithelial recovery following NE exposure.

PMID: 15923396 [PubMed - in process]



I started the post with my summary:
"For those complaining of nasal/sinus symptoms which they relate to Herceptin, the following two articles may hold clues as to what may be going on. The nose/airways have ciliated epithelial cells (lining cells with tiny hairs which help trap bacteria, molds and other particulates) and other specialized cells (including further down the "airways" in the bronchi and bronchioles). These articles raise questions which may help explain symptoms while on Herceptin--showing that her2 is necessary not just in embryogenesis, but also in adulthood for repair of these kinds of cells. They may help explain your nasal complaints, the reports of rare pulmonary problems in patients on Herceptin and perhaps the dry-eye problem I posted on before. The more they look into what her2 does, the more they find!:"

A “translation” of the “Greek” of the two articles:

Because of a case of a patient whose airways changed when Herceptin treatment was started and when Herceptin was stopped in terms of which types of specialized cells were present/absent they tried in a petri dish to see what happens to airway cells and found:

Trastuzumab treatment decreased the ciliated cell number by 49% and increased the metaplastic, flat cell number by 640%.

Thus the cells necessary to fight infection were more than halved and the cells with little specialized function, which do not secrete or trap bacteria, mold or particles went up by more than 6 fold.

In the other article, after bronchitis or other diseases where a white blood cell enzyme injures airway (bronchial) lining tissue her2 is necessary to repair the damage caused by this enzyme in an adult. The "Greek" is just describing how they proved the mechanism of how this occurs, at what step it occurs and whether the changes were on a gene or protein level.

Both articles emphasize that her2 fulfills physiologic functions in an adult and Herceptin can potentially adversely affect those functions. Epithelial cells are numberous throught the body--thhey line organs facing the "outside world"(which is sometimes inside as in the stomach and intestines) they function to keep infectious and dangerous particles out, secrete substances to lubricate and or digest, etc. Her2 seems to be necessary to keep these cells specializiing to serve different necessary functions and to repair/replace damaged cells.

Thus it seems it is not just the heart that Herceptin affects.

Re: Breathing Issues
 

Rhonda. How are you today? I hope you are breathing better now. Michka

Re: Breathing Issues
 

I am unfamiliar with the great garage door incident but it sounds like something I could probably identify with!!
I have had some experience with lung issues and people around me jumping to conclusions..so it is best to operate on the assumption that it is residual from your recent infection and/or medication as the others have suggested. The more likely, logical explaination. Although it is SO easy to go "there" as Chelee said.
Is the inhaler something your doctor ordered? Or OTC?
Keep the faith!

Re: Breathing Issues
 

Sassy,
I have been thinking about you. Has your SOB gotten any better? I thought with some more time, & your inhaler you might be feeling better? Maybe you have see your doctor by now? Sure hope there has been some improvement? When you find time check in and let me know how your doing?

(I also found Lani's post to be very interesting--timing of it is great! In fact it answers some questions I've had. If you see this Lani...thank you!) That's going to be very helpful to me.
Chelee

Re: Breathing Issues
 

Could you possibly have some food sensitivities? Dairy, Soy, Wheat/Glutton can all cause inflammation. Maybe try staying away from something you normally eat daily for 5 days and see if you feel better?

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Hope Sassy is cool, calm and breathing well now.

The information that Lani posted about the change of the type of cells in our airways due to Herceptin is SO interesting.

I have now been off Herceptin almost 3 years after being on for almost 8 years. I have many allergies year round. I seem to have less congestion this year now that it is "high" season for weeds and grasses.

Wonder if the cells have/will readjust in my airway now that I don't take H any more???

Re: Breathing Issues
 

Thanks for checking on me guys. I am breathing more easily. Inhaler has helped and I have been avoiding some products that I think may be irritants. I do have allergies, both environmental and food. Trying to walk more and do some water aerobics.

Went with my son to Univ of TN for orientation last Friday and the heat and humidity was fierce! Managed to walk the campus and breathe at the same time! His life long dream of becoming a Volunteer is coming true and I'm just wondering where my little boy went! Glad I'm still around to see him there!