COP basically is the diagnosis when we can't find the etiology of the findings on CT scan. There are some characteristic patterns on CT which I guess you demonstrated.

COP is classically very responsive to steroid therapy, typically starting with 1 mg/kg daily. Usually this dose is slowly tapered over several weeks. Sometimes it will come roaring back once off steroids, sometimes not. Really just depends on the patient.

If you're my patient and you're feeling well, no coughing, CT is getting better...I would forego the steroids.

DrHeadShrink said:

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I didn't have any side effects I noticed before but Prednisone has a LONG list of possibilities.
The pulmonologist said sometimes the culture doesn't find the cause and that situation is not unusual. Idiopathic seems to be the case?

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You may tolerate steroids well enough, but there is a risk of avascular necrosis of the hip from steroids, and the longer you are on them, the higher this risk becomes. There are people who take steroids every day of their life for decades and never get the problem, then there are those who take a relatively short course and end up with a hip replacement. One of my old partners was successfully sued by a patient who got AVN from steroids he had prescribed for nasal polyps with sinusitis, several short courses but nothing for that long of a period of time. If prednisone doesn't ultimately affect the outcome, I would hold off. Full disclosure, I am not a pulmonologist and have never treated anyone with your particular pulmonary condition.

What does "several short courses but nothing for that long of a period of time" consist of in terms of mg/day, number of days/course, and time between courses?

bigtruckguy3500 said:

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What does "several short courses but nothing for that long of a period of time" consist of in terms of mg/day, number of days/course, and time between courses?

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He had prescribed probably 3 Medrol dose packs and then a couple of 40x3, 30x3, 20x3, 10x3 prednisone tapers meant to be perioperative within a year. The patient had scheduled and then canceled surgery, he had lost his insurance and was calling in for refills without making appointments, etc.
The plaintiff had one hip replacement and was having serial MRIs looking at the other because of symptoms. The plaintiff's expert cited a lack of notification to the patient about this risk and overall poor documentation (my old Partner was trying to do the guy a favor by not making notes about a pre-existing condition, and the guy was trying to game the system to get surgery performed once he re-established insurance). Overall a ****ty story, but it was settled for several hundred thousand dollars.
My Partner was pretty down about the whole thing. He and I did a bunch of research about idiosyncratic AVN related to steroids, and there is a lot of literature about it and, of course, an entire cottage industry of attorneys looking to sue.
Point being, you don't have to be on steroids forever to get AVN.

Prednisone 60 mg x 7; 40 x 7; 20 x 7; 10 x 7; 5 x 7
The thought is to help continue the healing and avoid another inflammation so healing can take place. My lung doc was really sitting on the fence with this one. I lobbied to put me on another round. The last 3 week round ended October 2. I "vaguely" sense a cough trying to come back but that could easily be illness anxiety and being hyper vigilant. I think the relapse rate is 25-50%? Sure hope I'm not going to need a hip replacement soon but I realize this is quite uncommon but yet a real possibility.

Any updates on this? I actually just saw someone today with 11 months of a very productive cough, treated a few months ago for what looked like a pneumonia, with only temporary improvement. Now with a worsening chest xray showing infiltrates in the low lung, worse on the left. Going to get a CT scan soon. No fever, chills, weight loss. Radiolgist said infectious vs inflammatory process but malignancy can't be excluded.

Reminded me of this whole ordeal.