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Old 06-01-2006, 11:33 AM   #1
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New, is it really asthma?

I've been lurking around the board for a week or so and find this to a great source of of info for the average person. (of course remembering to always do my own follow up. )

I have been coughing for 18 months now, and the drs are stumped about what my problem is. I had several nasty colds in a row and after that the cough would not leave. Went to my GP and he gave me antibiotics and albuterol and sent me on my way, just saying I had the same thing every one else was getting. I felt a little better after the antibiotic but the cough lingered. And I wasn't real comfortable using the albuterol without knowing why I was using it. So after coughing for another 5 months I went looking for a second opinion with an allergy and asthma specialist. Turns out I'm not allergic to anything. I didn't have a sinus infection (clear CT) (had some post nasal drip at the time). I had decent peak flows, not the best, but well within the normal range. So he figured I had asthma. I was put on Advair 250, Zyrtec (was already taking it for previously presumed allergies), and told when to use the albuterol. After a few months I started to feel better. The cough got to the point where I was no longer noticing it. We decided to try lowering the Advair to once a day and the cough came back, so we we went back to 2x a day. Got better again. Come fall and cold weather I started to have problems again, especially when I was out breathing cold air. Cough came back so we added singulair. That seemed to help for a few months. But then the cough came back again. Dr was starting to wonder. (Peak flows hadn't really changed any during all this.) So we did a methacholine challenge. I had a negative result which is supposed to mean that I do not have asthma. So the Dr wondered if it was 'silent' GERD and put me on protronix, kept the advair 1x day, albutrol as needed (seems to help stop cough) and cut the zyrtec and singluair. That didn't seem to make much of a difference so he added Reglan. At this point I had a peak flow that was as much as 200cc better than it had ever been before. The odd thing is that this was only 2 days after I had had a flare up after cleaning my bathroom.

My Dr is so stumped he sent me for another opinion. Now 2 weeks later I've had a lower peak flow again. I'm not sure this Dr had a chance to read my chart before he saw me, because I've been relabeled as asthma after being told I don't have it. He upped all my meds to 2x a day and said to call back if I am not 100% better in a week. It's been 3 days and I haven't seen much change. I have to use my albuterol almost every 4 hours to control my cough.

The cough is semi-productive (I always swallow it before I cough it out. Gross I know.) I have a tight feeling in the very center of my chest. I don't really wheeze but I have been known to in the past. Triggers seem to be dust, Tilex, cigarette smoke, some glass cleaners, some colognes, and a polymer used to make printing plates. I also seem to be worse at work than I am at home. (I have a desk job as a structural designer.)

I'm at my wits end trying to find out what I have. I just want to stop coughing. Could I have had a false negative on the Methacholine test? Any ideas are greatly appreciated.

thx,
blue

 
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Old 06-01-2006, 02:43 PM   #2
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Re: New, is it really asthma?

Quick question, when you had the methacholine test were you taking antihistamines or had taken them in the 48hrs prior to your test? had you had your inhalers within 12hrs of the test? had you been drinking coffee or anyother caffine containing food or drink within the 8hrs of your test?

All those factors could cause you to have a false-negative result.

 
Old 06-01-2006, 03:28 PM   #3
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Re: New, is it really asthma?

I was off all my meds for 3 days before the test. It was first thing in the morning. I didn't have any caffeine or chocolate beforehand. The doctors office was good about telling how to prepare for the test.

 
Old 06-01-2006, 09:50 PM   #4
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Re: New, is it really asthma?--long response

bluedog139-

Your story sounds remarkably like mine. I can very much relate to what you are going through.

I have had a chronic cough since December of 2001. I volunteered during the Olympics shortly after that and spent the entire time coughing. That was when I was first diagnosed with asthma. Before that, I had only had experience with asthma through people I know who used to wheeze. I had not wheezing and coughing was my only symptom. That year I was put on a variety of asthma medications and tried several dosages. At that time I was already on Allegra D and Flonase for year round allergies. For the next couple years, I had sporatic bouts of chronic coughs lasting weeks or a couple months at a time.

In January 2005, I got another sinus infection. I was treated with a couple rounds of antibiotics and seemed to get better. About a week after my sinus symptoms disappeared, the cough started in again. This time it was worse than ever. I couldn't stop coughing. It was the kind of coughing that had me doubled over, pulling somach and rib muscles, and occassionally vomiting when I couldn't breath. It affected not only me, but everyone around me. The doctor put me on additional antibiotics...just in case. She also strengthened my Advair to 250/50 and told me to use my Albuteral as much as I needed. The cough continued. I went back in and was put on prednisone. That didn't help. I was put on Advair 500/50 and a new prescription for acid reflux and codine (as needed to help sleep). The cough continued. I had chest x-rays--nothing. I was then also put on Singulair and given tessalon perle to help with the cough. The cough continues.

As I was going through this process, the doctor explained that chronic cough is generally caused by 4 main things:
post nasal drip, allergies, acid reflux and asthma. She said in some people the cough could be the primary symptom for any of these. She treated me for all. I should explain that I already know I had allergies and completed immunotherapy. I had never noticed any acid reflux symptoms until after I went off of acid reflux medication they put me on for the cough. I also never had wheezing with my asthma. I did have things that set off the cough though--cold air, chemical cleaners, smoke, perfume, scented candles, inversions, sometimes even just walking down the hall.


I kept going in to the doctor when each thing I tried didn't work. I had bloodwork done several times and two tests done for pertussis (whooping cough). The tests for pertussis were confusing because even though they were different tests they both came back inconclusive because I had received my immunizations when I was young. They said if I had it I had already been treated with the antibiotics I had been on-I will never know if I actually had it. Throughout all this, I wore my immune system down and eventually lost my voice and got the flu. This is the first bug I have ever had that caused me to miss work. (Ten years on the job and I had never had a sick day. I never missed for the sinus infections--just suffered through it.) Finally, after four months, the cough got better. By this time, I was on Advair 500/50, Allegra-D, Singulair, Albuterol, Mucinex (as needed), Flonase, Astelin and Protonix. I had the cough for 4 1/2 months. I was having monthly follow-up appoints with my doctor to monitor my condition. After I found a good balance that helped control my cough, I did better. The doctor eventually reduced the Advair to 250/50.

Then comes January 2006. I was still on all of those maintainence prescriptions. I got another sinus/ear infection. A couple weeks later, the cough started again. The doctor gave me Advair 500/50, prednisone, and more antibiotics. I had some blood testing done with no results. At the next visit, I was also tested for a genetic condition that causes coughing (it came back negative). The cough continued. I was constantly using the Albuterol. I went back in. The doctor tried a new acid reflux medication-- Nexium--which I later found out insurance wouldn't cover. I was then put on Prevacid one time a day. At this point, the doctor said she didn't know what else she could do. I was referred to the GI Specialist. I had an Endoscopy that didn't show anything. I had a 24 hour PH that showed I did have some acid. They put me on Prevacid twice a day. Ironically, by the time all these tests were scheduled, my cough wasn't as frequent. I had a follow-up with my primary physican last month and she refused to reduce any of my medications or dosages because I have seemed to found a balance in the treatment of all causes of the cough. Next time the cough starts up again, I am supposed to go to a Pulminologist. The referral has already been written up by my doctor. I am hopeful because I have been almost two months mostly cough free. I am really worried about the spring/summer allergies upsetting my current balance. I usually get summer sinus infections that seem to trigger coughing.

With all of these approaches for treating the cough, I don't know what finally worked and what the cause of the cough was. I assume all areas listed were causing the cough, but when one is out of balance, it seems to throw the others off also. At this time, I would love to find a way to get off of all of these medications. I am paying out $350/mo. in co-pays and praying the cough doesn't return as bad.

Last edited by MountainReader; 06-01-2006 at 09:53 PM.

 
Old 06-02-2006, 04:33 AM   #5
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Re: New, is it really asthma?

Bluedog,

Why don't you check out the "Acid Reflux" message board here at healthhboards? About 1/2 of the posters have LPR - the cough variant form of acid reflux, called Laryngopharyngeal Reflux. It's not GERD. It also is usually the cause of chronic cough that does not respond to anitbiotics or asthma medications.

The critical thing in threating LPR (which is reflux in the throat) is that you must take 2 PPIs a day. I know you are on 1 PPI per day right now, but standard treatment for LPR is 2, and it makes a world of difference. There is an enormous amount of research and clinical evidence that supports this dosage stratgegy.

You have your choice of PPIs: Nexium, Aciphix, Prevacid, Protonix. If at the 2x per day level, 1 doesn't clear up your problem after 1 month, then move on to the next brand. The message is experiment, experiment, experiment.

Nexium is the most recently launched PPI and is them most structurally different of the bunch. Some insurers won't cover it, but it's often the most effective PPI.

There is lots of information about LPR over at the "Acid Reflux" message board here at Healthboards. Why don't you come by and read the posts?

 
Old 06-02-2006, 04:48 AM   #6
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Re: New, is it really asthma?

Thanks for the replies. I am on Protronix, Reglan and advair twice a day. I had been on it 2x day before but it made little difference. If I'm not better in a few days I'm to call the doctor. I think it's unlikely I'll be as good as he wants me to be by then.

What really gets to me is all the tier 3 Rxs that I have that are unfinished. The dr will give me samples but I live over an hour away from the office so it's not practical to get them.

I'm going to give this dr a chance to figure things out. But if something doesn't change soon I'll be looking for another dr, just don't know where to start. I hate looking for doctors. Though they've said they'll refer me to the local university medical center if they can't figure anything out.

 
Old 06-02-2006, 07:29 PM   #7
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Re: New, is it really asthma?

hmmm , you sound like me in the sense you have that chronic cough triggered by things like smoke, cleaners, etc after a cold that lingers. I finally tracked mine and when it was going on months after a cold I saw a pulmonologist who did a chest xray, blood work and metha choline challenge. I did fail that and had to use albuterol to breath again. First we tried environmental changes, but the cough lingered. So he gave me advair and unlike you 4, yes 4 DAYS later my cough was gone I was thrilled. It does sound like you were warned about what to avoid. Is it possible to have the results interpreted by someone else? Is it possible it was not administered correctly. Was your nose clamped shut, things like that ? Hey I had an xray 18 years ago that said my neck was fine- when it was broken!!! So I would think it might be worth re-evaluating the test. Does the dr know the person who did it? Good luck and explore everything, has your esophagus itself been examined. The mucus for me was pretty light until I got sick. Also maybe changing antibiotics can sometime make the difference, perhaps you've built a resistance to one and maybe the strain of bacteria does not respond to the certain one, can the do a culture?

 
Old 06-06-2006, 12:56 PM   #8
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Angry New, is it really asthma?

I am

My symptons similar to yours.

I am 28 yrs old. I had this now for over 15 years the max. The doctors say its asthma. I know it isnt!

I cough everyday..maybe every hour. Its a violent cough and even I get worried.

1. I cough when I speak to people / on the phone. Then I start retching...
2. It leads to vomit / your throat is so dry you have nothing left but you still vomit.
3. You retch aswell. LIke vomit sound but no vomit.
4. My symptons worst if I get hot / cold, in a dusty environment, smoky environment.

Doctors given me inhalers. I keep telling them its not working so they do blood tests and find nothing. I ask for a throat xray / checkup and they havent done that.

THEY IGNORE ME.... say its ASTHMA. I asked people with asthma what their symptons are and they say wheezing / shortness in breath (NO COUGH).

Any doctors out there - can you help?
I taken preventer and reliever inhalers - doesnt work. Its been 15 years. I work as a Police Officer and these coughs are so embarrasing esp when I vomit. I am now pregnant and I dont wont this!

 
Old 06-06-2006, 01:04 PM   #9
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Re: New, is it really asthma?

HOPE THERE IS A CURE..... I REALLY DO!

I AM WILLING TO BE PART OF ANY TESTS IF NEED BE.... I DO NOT WANT THIS ANNOYING COUGH....

 
Old 06-06-2006, 04:29 PM   #10
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Re: New, is it really asthma?

JOT,

I know it can be fustrating. You're in the UK and I know that that can make it harder to see specialists. Just keep bugging you GP to send you to specialists. The test for asthma is a Methacholine Challenge. Usually it's the only way to tell if it is really asthma. There is a type of asthma that the main symptom is cough, cough varient asthma. There is also VCD, (vocal chord disorder/disease) that can cause cough. Only thing I can say is keep trying. If one Dr won't listen, find another. I know it's hard, but we are our own best advocate.

 
Old 06-06-2006, 08:10 PM   #11
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Re: New, is it really asthma?

Jot- just one word of caution- ASK if the methacholine challeng is safe if you are pregnant??
I threw up for 7 months while pregnant for pregnancy reasons and still gained weight and had a healthy baby!!! Please any meds, please make sure they know you are pregnant!!!
I really hope you can get answers but I DON"T KNOW if it MIGHT be safer to wait until after the baby is born, just be sure whoever is testing, prescribing knows!!! Best of luck!!!!!!!!!!!!!

 
Old 06-06-2006, 11:58 PM   #12
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Re: New, is it really asthma?

Thank You for replying..... I will make a appointment on Friday. I will also print what you have written.... only if we (UK) could sue the doctors for anything and everything ehh.... THANK YOU....

How are you feeling now? Has your cough disappeared?

 
Old 06-06-2006, 11:59 PM   #13
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Re: New, is it really asthma?

Quote:
Originally Posted by bluedog139
JOT,

I know it can be fustrating. You're in the UK and I know that that can make it harder to see specialists. Just keep bugging you GP to send you to specialists. The test for asthma is a Methacholine Challenge. Usually it's the only way to tell if it is really asthma. There is a type of asthma that the main symptom is cough, cough varient asthma. There is also VCD, (vocal chord disorder/disease) that can cause cough. Only thing I can say is keep trying. If one Dr won't listen, find another. I know it's hard, but we are our own best advocate.
bLUEdOg - Has your cough disappeared?

 
Old 06-07-2006, 04:31 AM   #14
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Re: New, is it really asthma?

I am feeling better. I'd say about 85% normal. I still get some chest tightness that the albuterol relieves. Which is why I question the negative Methacholine test that I had. It is usually more than one thing that causes chronic cough in most people. So I may have GERD and mild asthma. JOT, hope you get to feeling better, especially with a little one on the way.

 
Old 06-07-2006, 10:14 AM   #15
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Wink Re: New, is it really asthma?

Too be honest .. some days are no cough and some days are violent coughs. I will print out this forum and go to the docs or the hospital. We have NHS here (free doctors / hospitals) and they sometime ignore the NHS patient and prefer to deal with private patients (who pay money).

Thank YOU for replying to me. I am happy that someone out there has similar or same symptons like me. Its like I can actually talk to someone!

Thanks

 
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