Respiratory immunopathology

See stage 5 risks for patients with lung biopsies

Early recognition and effective management of immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed. are very important when a patient has respiratory symptoms.

Immunopathology may be mistaken for an upper respiratory infection.

Any symptom that correlates with MP therapy may be due to immunopathology. Whenever the cause of symptoms is in doubt, an extra Benicar may help dampen them. Increase Benicar to every four hours (for 24 hours if no immediate result) to see if it relieves symptoms.

If adjustment of MP meds fails to control respiratory symptoms, a steroid inhaler/puffer (or nasal spray) might be effective quickly in an emergency situation.

A cough can develop at any time in sarcoidosis. It can be related to anything from upper respiratory involvement and post-nasal drip to chest involvement or even triggered by exposure to dust, fungus, odors or fumes.

You should monitor coughing as you would any other symptom of immunopathology to keep it tolerable. Coughing can be very tiring, not just to you, but to others around you. The physical exertion as well as the sound tends to be a mental drain as well. Most of the coughing associated with sarcoidosis doesn't bring up phlegm, which may worry some folks as well (because it is non-productive).

I found that immunopathology resulted in coughing and breathing difficulties on the MP, it was imperative that I stop and rest. Even if I didn't fall asleep, frequent resting helped improve coughing and fatigue. So, rest.. rest.. rest.

Belinda, MarshallProtocol.com

Cold-like symptoms, including coughing, are a common immune system reaction. Getting well with the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. always involves immune system reactions. These reactions can be symptoms you currently have, symptoms you've had before or brand new symptoms.

The MP will make no difference to the course of a cold. If anything, it will allow the immune system a better chance to fight the virus. On the other hand, flu-like symptoms are a very common manifestation of immunopathology. They come and go more quickly than a viral cold does.

Pay attention to the nature of the cough. As the immune system starts to properly work again, the coughing changes perceptibly. Whereas the coughing of sarcoidosis is shallow and non-productive, once the immune system kicks back in the coughing is always productive, and usually involves more chest muscles, particularly the lower ones.

Trevor Marshall, PhD

The following are non-medication strategies to help palliate respiratory symptoms:

• Drink more fluids. Water helps loosen mucus and soothe an irritated throat.
• Elevate your head with extra pillows at night to ease a dry cough.
• Try a cough drop to soothe an irritated throat. Expensive medicine-flavored cough drops are not any better than inexpensive candy-flavored ones or hard candy. Most cough drops have no effect on the cough-producing mechanism. Cough drops sweetened with sucralose instead of sugar are available.
• Avoid exposure to inhaled irritants, such as smoke, dust, or other pollutants, or wear a face mask that is appropriate for the exposure.
• Saline nasal spray or a water-soluble clear gel (Ayr is one OTC brand) used regularly will keep blocked nasal passages moist and allow easier removal of debris. You may also use petroleum jelly to keep nostrils moist.
• Nasal irrigation may provide some relief from sinus congestion.
• Elevate the head of your bed 4 to 6 inches. This can help keep mucus from interfering with breathing at night.
• If nasal congestion prevents air passage, OTC decongestants can be used judiciously.
• Avoid aerosols, fragrances or chemicals that may aggravate breathing.
• Breathing exercises can improve breathing ability and reduce SOB. A respiratory therapist can provide guidance for breathing exercises and many clinics have respiratory programs to teach patients how to cope with reduced respiratory function.
• Remember that pacing and rest are very important. By being pushed to the limit of tolerable immunopathologyA state in which a patient has maintained an acceptable intensity of bacterial die-off reaction. The primary goal of the Marshall Protocol., the body is working to capacity.

An MP patient should contact his or her physician or pharmacist for advice about palliative medications or other treatments that can be used to provide temporary relief of symptoms such as shortness of breath, nasal congestion, gastric upset or pain.

• For congestion, use sudaphedrine or ephedrine (Sudafed).
• To suppress an intolerable cough use dextromethorphan (DM). Use an expectorant, guaifenesin, during the day to loosen a cough and help bring up sputum.
• For a runny nose, use an antihistamine. Diphenhydramine (Benadryl) works well, is short-acting and causes drowsiness. Claritin (Loratadine) can be used in the daytime. There are also long-acting antihistamines available by prescription only, such as Zyrtec and Allegra. Note: These should be used only while symptoms are intolerable.
• Vitamin C - Ascorbates promote the transcription of Th1 inflammatory mediators' and, therefore, supplemental vitamin C (ascorbic acid) may prove to affect the immune system in a way that is counterproductive. Because Vitamin C affects the immune system in yet-unknown ways, supplementation is contraindicated.
• Zinc lozenges are thought to prevent viruses from multiplying in the throat, but there is no scientific proof of this.
• Expectorants may help thin the mucus (phlegm) and make it easier to expectorate it. An expectorant is helpful for a cough that produces thick mucus that is difficult to cough up.
• Some pulmonologists will administer mucomyst by high-flow nebulizer to attempt to thin secretions, the same principle behind guaifenesin pills or syrup and may be helpful.
• Codeine is very useful if you need to suppress a cough that is doing no good, but usually you want to cough up as much as you reasonably can.
• Inhalers containing a bronchodilator medication (avoid inhaled steroids) may relieve SOB.
• A medication for anxiety may calm respiratory symptoms.

It is fine to use Ventolin without Flovent. Hundreds of thousands of folks use it alone. Some people find benefit from Atrovent with the Ventolin, and your doc will know about this. If the Ventolin works by itself there is no need for any other lung med. Flovent is to be avoided routinely because it is a steroid, but it could still be used in an absolute emergency situation. It is much better to control the immune system response with Benicar and antibiotic adjustments, as Flovent shuts down your immune system.

P.Bear, RN, MarshallProtocol.com

Guaifenisen may palliate all lung symptoms, not just coughing, and reduce systemic immunupathology also. Use normal doses of an OTC product that does not contain any other ingredients. MP patients may find a slight surge of symptoms during “withdrawal” from periods of intense guaifenesin use. MP patients should discuss the use of guaifenisin with their physicians.

Guaifenesin works by drawing water into the bronchi. The water both thins mucus and lubricates the airway, facilitating the removal of mucus by coughing. One may notice a sense of dry mouth when taking guaifenesin. Water consumption is important, not only to help with dry mouth, but also to improve the effectiveness of the drug.

Guaifenesin is sold as pills or syrups under several brand names such as Guai-Aid, GuaiLife, Ethex 208, Humibid, Mucinex, and Robitussin.

Single-ingredient guiafenesin (tablets or liquid) are preferable to any combination products which may contain ingredients such as decongestants, antihistamines or cough suppressants which you may not need. Be sure you know what you are taking.

Persistent coughing can strain the muscles or ligaments of the chest wall. When these muscles are strained, even normal breathing can cause mild chest pain. Constant coughing can be exhausting or occur when you are trying to sleep.

If chest wall pain, fatigue or insomnia due to coughing become intolerable, it is helpful to suppress your cough.

Cough suppressants should be used carefully if your cough is wet-sounding and produces mucous (phlegm) because it is important to cough up this mucous to prevent an acute respiratory infection. If your cough is usually productive but you need to suppress it to get some relief, use only enough cough suppressant to keep chest wall pain and/or fatigue tolerable or only when you must get some sleep.

Dextromethorphan acts on the center in the brain that controls the cough reflex. It is available over the counter and is an ingredient in many cough medicines, such as Vicks Formula 44, Drixoral Cough Liquid Caps, Sucrets Cough Control, Benylin DM and some Robitussin products. It rarely causes side effects, although an upset stomach or drowsiness can occur.

Many OTC cough medicines are combinations products that contain other ingredients beside a cough suppressant, such as an expectorant, decongestant or antihistamine. Look for a single ingredient dextromethorphan product. Even if you also need an expectorant, single use products allow you better control so you are only taking one medication, as needed, for one specific purpose. For example, you may use an expectorant during the daytime and a cough suppressant at nighttime when you want to sleep.

Codeine is an opioid (narcotic) that acts on the vegas nerve to suppress coughing. It is available only by prescription in many states. However, other states permit pharmacists to sell cough remedies containing codeine without a prescription if the customer signs for it. Because codeine is an opioid, some people fear it may be addicting. In reality, addiction is uncommon. Codeine can be helpful at bedtime because of its slight sedative effect.

Theobromine, also known as xantheose, is a bitter alkaloid of the cacoa plant, and is therefore found in chocolate. “Recent studies have found that theobromine, which is a compound found in cacao, is more effective as a cough suppressant than prescription codeine. This molecule suppresses the 'itch' signal from the nerve in the back of the throat that causes the cough reflex. It is possible to get an effective dose from 50g of dark chocolate, which contain 2-10 times more cocao than milk chocolate. Theobromine was also free of side effects in the blind tests.[1]” Persistent coughs melt away with chocolate

Dark chocolate candy has a high sugar content to counteract the natural bitterness. Sugar-free dark chocolate can be found. Here is one online source: http://www.lowcarbchocolates.com/rossbars.html

They sell a dark chocolate bar is 34g and is sweetened with maltitol (note the side effects). Note that this is a relatively large amount of chocolate to reach the suggested effective dose of 50g. This company has a sale each Spring and Fall. You may ask to be put on their email list if you are interested.

If your progress on the MP is hampered in any way, then you should reexamine your medications.

Use of supplemental oxygen is most effective in relieving immunopathology associated with breathing. It is recommended that all sarcoidosis patients have oxygen available to deal with unexpected immunopathology. Patients at risk should ask their physicians to assess their need for supplemental oxygen.

Those who have severe respiratory disease are encouraged to keep an oxygen concentrator handy well into phase 3, out of an abundance of caution.

If your respiratory function is poor, it is important to prevent an acute infection.

If you are ever concerned, don't hesitate to contact your doctor. Your doctor may also contact Dr. Marshall.

If your activity level is low and you are unable to tolerate mild exercise, use of an incentive inspirometer to expand pulmonary tissues may excercise the lungs to promote a more even bacterial kill during the process of recovery. This may prevent uncontrollable respiratory immunopathology during stage 5 of the immune system recovery. See purchasing information here.

A feel of throat tightening, lump in the throat or difficulty swallowing is due to inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. causing a lack of muscle coordination. This is reported often by folks with Th1 disease. Take measures to reduce immunopathology. If symptoms threaten to close airway, seek medical attention immediately.

Swallowing is a process that requires correct functioning of the salivary glands, tongue, pharynx, larynx, esophogus and associated muscles and nerves. It is not unusual for people with sarcoidosis or other Th1 disease to experience dysphagia, difficulty swallowing as a symptom and as immunopathology.

It is possible for dysphagia to begin abruptly, but you can be on the alert for alterations in the functioning of your throat and voice box which would signal you might also have a problem if you ate at that time. The vocal cords must be able to close properly to avoid choking.

To avoid experiencing this intolerable immunopathologyAn unbearable or unsafe severity of bacterial die-off reaction. by maintaining the Benicar blockade, ensure that your Benicar dosing doesn't lapse before you eat. It will not do any good to try to take oral Benicar at the time you are having dysphagia. Chewing the tablet and placing it under the tongue may provide faster symptom relief.

Emergency medical personnel should know that a patient is on the MP. This notice for health care providers provides information that emergency medical personnel need to know.

There were several ways my immune system reactions affected my symptoms and breathing:

Your cough is a symptom that flares when you are experiencing immunopathology, and it becomes less intense as you have slowed your immune system reaction. You will be gaining experience by managing your immunopathology around this signal symptom. Tolerable immunopathology is sustainable, and is the level to aim for at all times.

1) My throat could tighten so I couldn't inhale correctly. I had to pay attention to the warning signs that would precede “throat tightening.” The most obvious signal was that my voice would get tighter and higher-pitched before my throat would tighten.

2) My chest muscles could get sluggish and be hard to move. Chest muscles prompt breathing by expanding to provoke lung inflation. I found I was more likely to have sluggish chest muscles in the afternoon or evening, when fatigue was more of a problem. Sometimes my chest muscles felt swollen - the swelling was actually visible - and I would get muscle twitches. I learned to rest more and take a nap when I encountered this sort of problem. In early treatment, I had supplemental oxygen, which I used during these times.

3) I had enlarged lymph nodes in my chest that pressed on my airways. On some immunopathology days, the pressure from inside my chest was worse and made it harder to breathe. It was sort of like that feeling of not having enough “room to breathe” that occurs when you are very pregnant (if you've ever had that experience), although the pressure came from inside my chest instead of from below (as in pregnancy).

4) I was able to wean off supplemental oxygen and use it only when the immune system reaction was severe, until I weaned off oxygen completely. I can still get short of breath now, even though I walk 3-4 miles per day. If I walk with a friend and talk a lot or walk and talk while climbing stairs, I can get SOB. Or if I walk outdoors on a bad ozone day, I feel like I can't get enough air. So, I walk indoors when ozone warnings are in effect.

My experience is with sarcoidosis, which can cause decreased lung volume. But originally, I was “diagnosed” with “asthma” due to complaints of shortness of breath (SOB) and coughing (in spite of the fact that I had a lot of other symptoms that would indicate sarc instead). Sometimes, but not often, I had wheezing or crackling sounds from my lungs. When I breathed, sometimes my lungs felt “squishy,” the way your feet feel when walking in wet tennis shoes. Inhalers didn't help me, but unfortunately physicians can assume people don't use inhalers properly. It was only when I had complete pulmonary function tests, with testing before and after bronchodilators were used, that doctors were finally convinced bronchodilators didn't help.

Did you assume you have a decrease in lung volume, or did you get results from pulmonary function tests (PFTs) indicating a decrease in lung volume? It may be that immunopathology might temporarily cause some changes, but they might not show up on any tests. If I had it to do over again, I would insist on having PFTs done before accepting a diagnosis of asthma.

To sum up my experience, before I started the MP, I coughed pretty much all the time. (It drove everyone around me crazy!) That intense coughing left my chest muscles exhausted, and I relied on supplemental oxygen by early afternoon many days. Originally, my PFTs indicated both restrictive (reduced volume) and obstructive lung disease (due to lymph nodes impinging on airways). Now I no longer have obstructive lung disease (the lymph nodes decreased in size) and have only a mildly-restrictive pattern on PFTs. My doctor withdrew supplemental oxygen after I was on the MP for about a year and a half.

If bronchodilators didn't change your PFTs, you should probably bring it to your doctor's attention if he persists in wanting to treat you for asthma. It's something you will want to discuss with him. The fact that bronchodilators didn't relieve your problem would seem to indicate your experience may not be asthma.

I still suspect immunopathology is making this old symptom flare. Can you think of any other factors that might be contributing? For instance, I had more trouble breathing when it was very humid, and cool humid air was *the worst*. Also, any upper respiratory problems (like a stuffy nose or sinus blockage) may make breathing more difficult.

Do you monitor the air quality in your area, to see if there are any air quality warnings? If you live in an area with air problems such as smog or high ozone, you should monitor that to see if your symptoms correlate with bad air quality days. The AQI is not something you can tell by looking outdoors. The Environmental Protection Agency calculates the air quality index. Where I live, our air quality has been rated orange lately, which means “unhealthy for sensitive groups.” Any time I feel like I have to exert more energy to breathe, it's because our AQI is either orange or red.

Getting tired makes it more likely to experience the shallow breathing, too. It's good to rest more when experiencing an immune system reaction. After all, the road to recovery is a long road. So, go easy on yourself.

My coughing was usually unproductive. My chest would feel tight, heavy and even painful and the cough came from so deep down it felt as if I might cough up my toes. But more often than not, nothing came up. That's why they say the sarcoidosis cough is unproductive; no phlegm comes up. Unless the mucous is draining from the sinuses, it's probably not in a place you can cough it up.

It may help you to understand that sarcoidosis often inflames the tiny air sacs in the lungs, the alveoli.

Using supplemental oxygen reassured me that my heart and lungs were less likely to be oxygen deprived.

Belinda, MarshallProtocol.com