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Old 06-12-2009, 02:26 PM   #1
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Possible CVA Diagnosis

Hello.
I've had a chronic cough off and on for years. Ten years ago I was diagnosed with asthma, but the PFT came back stellar so the doctor withdrew his diagnosis. However, my chronic cough is back and much worse. My doctor, having treated with antibiotics for bronchial infection unsuccessfully, has diagnosed me with "hyperactive airways disease." I think he's headed toward the diagnosis of CVA, and it seems to fit. Here are my major symptoms. Could one of the CVA veterans please tell me if this sounds like CVA?
  • chronic dry cough ("barking") that gets worse as the day goes on
  • Little cough lying down or resting
  • Cough gets worse with exercise (Yesterday out of the blue, a woman at the gym walked up to the treadmill I was on and handed me a cough drop!)
  • No wheezing or shortness of breath, except when I'm coughing so much I can't catch my breath
  • Cough gets worse in cold air, including in the frozen foods aisle of the grocery store
  • Cough is moderately responsive to Proventil. Proventil mainly gets rid of the tightness in my chest and improves the cough somewhat.

My worst fear is that they won't be able to diagnose anything and my cough will go on indefinitely. Frankly, I don't care if they call it "Jimmy Dean Sausage Disease"; I just want to feel better.
Thanks!
Karen

 
Old 06-12-2009, 04:06 PM   #2
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Re: Possible CVA Diagnosis

Has acid reflux come up in the discussion? A friend of mine had similar symptoms to yours. Everyone assumed asthma and her GP and ENT treated her for it. Never got better...finally sent her to my allergy doc. Did a PFT and all the allergy testing - she has acid reflux. Within a week she felt 100% improved. No one else ever thought of it.

 
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Old 06-12-2009, 04:54 PM   #3
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Re: Possible CVA Diagnosis

Quote:
Originally Posted by Titchou View Post
Has acid reflux come up in the discussion? A friend of mine had similar symptoms to yours. Everyone assumed asthma and her GP and ENT treated her for it. Never got better...finally sent her to my allergy doc. Did a PFT and all the allergy testing - she has acid reflux. Within a week she felt 100% improved. No one else ever thought of it.
That hasn't come up yet, but I don't have any symptoms of acid reflux like heartburn, nausea, discomfort after eating, etc. I'll mention it to my doc, though. Thanks.

 
Old 06-12-2009, 05:06 PM   #4
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Re: Possible CVA Diagnosis

neither did my friend! She was totally stunned. Just a suggestion.

 
Old 06-12-2009, 06:29 PM   #5
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Re: Possible CVA Diagnosis

Quote:
Originally Posted by Titchou View Post
neither did my friend! She was totally stunned. Just a suggestion.
It's a good one. I've narrowed this down to CVA, GERD, or Post-nasal drip syndrome. All can cause the chronic, dry cough. We'll see what the doc says.

 
Old 06-13-2009, 06:33 AM   #6
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Re: Possible CVA Diagnosis

Your symptoms sound pretty much like mine before I was diagnosed. With cough variant asthma, many times pfts will be normal. I can be coughing my head off & get great numbers. When I was trying to get a diagnosis, I was too sick to get any testing (methacholine challenge can confirm asthma if your pfts are normal), so my dr tried me on asthma meds,(prednisone, pulmicort, albuterol) & right away I began to improve. You are like me, when lying still, my cough would really ease up. The only thing I could do comfortably before I was diagnosed was sleep :-) Although you could still have gerd, normally you would be worse when lying down, not better. I totally understand your frustration. When I tried my first allergist, I told him my worst fear (which was the same as yours!) & he said "well, I guess it has come true, you are just going to have to get used to it !" I left his office in tears and coughed for another year until I stumbled across the allergist that finally diagnosed me. Do you have allergies? Or any family history of allergies/asthma? Maybe you could talk to your dr about trying you on asthma meds? Proventil is not really a preventative, maybe you could try a steroid inhaler or something to see if there is a change? Good luck to you, keep us posted. I have been where you are, keep pushing the drs to figure it out, for some reason they seem not to realize how disruptive constant coughing is to living your life.

 
Old 06-13-2009, 04:56 PM   #7
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Re: Possible CVA Diagnosis

Thank you! Your sympathy is very much appreciated. I am on Proventil, which helps some. More than anything it seems to have a cumulative effect; I'm much better now than before I started five days ago, although I still cough. Also, the Proventil eases the tightness in my chest.

To answer your question, I have confirmed allergies to mold and dust mites, and, since we just moved to AZ and suddenly my symptoms got tons worse, I'm thinking there is something out here (mesquite trees are common irritants) that is irritating my lungs. No family history of known asthma, but yes on allergies, which is why I'm a little stunned by a possible asthma diagnosis.

Anyway, thanks for the info and the support. I'll keep you posted.
Karen

 
Old 06-14-2009, 12:50 PM   #8
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Re: Possible CVA Diagnosis

It has already been mentioned in previous posts, but the most common causes of chronic dry coughs are:
  • asthma
  • allergies
  • post nasal drip
  • acid reflux

Frequently, there are more than one of the above triggering the cough.

I've had PFT's come back normal, but still have a diagnosis of asthma--severe at times. Having times when I have things under control enough to have a normal PFT is a good thing in my book.

From what you write, it does sound like CVA may be an appropriate diagnosis for you. That is the type I have also. Coughing is my primary asthma symptom. I have many of the same triggers you listed as well.

I also have "silent" reflux. My primary reflux symptom is a cough as well. I often have difficulties figuring out if it is asthma or reflux when I cough. Ironically, reflux can come up and irritate your lungs, causing the cough. Also, coughing can tighten the stomach making you reflux which can trigger the asthma as well. It is a tough circle. Try researching Laryngopharyngeal Reflux (LPR).. Most people just call it LPR. It is reflux that has no "typical" symptoms. Instead symptoms can be coughing, hoarseness, feeling of something in the throat, etc... Like I said before, coughing was my reflux symptom. It took further testing by my Pulmonologist to confirm this.

You also want to watch your allergies to make sure they are under control because if not they can trigger your asthma as well.

By the way, I have absolutely no family history of asthma either. There is a strong link between allergies and asthma though.

You don't say how long you have had this cough. If it has been less than 3 months, you might ask your doctor about testing for Pertussis (Whooping Cough). The symptom for it is a bad cough that can have a "bark" to it for some. The incidents of Pertussis are on the rise. Those immunizations we got when we are younger do not protect into adulthood. I would think this would have been reflected in PFT's though. It is hard to get a good breath when you have it.

 
Old 06-15-2009, 08:34 AM   #9
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Re: Possible CVA Diagnosis

Dear MountainReader,
Thanks! I've been wondering if I'm in vicious circle myself, as though the allergies/asthma bring out the worst in each other. I definitely have allergies to dust and mold, and i'm wondering if I've developed some new ones is the 10 years since I've been tested. I've had this cough off and on for YEARS, so I doubt it's Whooping Cough, but that might be worth a mention. In any event, I can't wait to see my doc this week; after all the great info I've gotten on these boards, we'll have a lot to talk over.
Thanks again! Good luck to you as well.
Karen

 
Old 06-25-2009, 03:32 PM   #10
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Re: Possible CVA Diagnosis

Hi, everyone.
Well, the pulmonologist suspects CVA like everyone else. He started me on Advair and has scheduled some tests, which he said will probably be normal. I've had 4 doses of Advair and I want to say it's working, because i see small improvements, but I don't want to get too excited just yet. Anyway, I hope this is the answer!

 
Old 06-25-2009, 05:59 PM   #11
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Re: Possible CVA Diagnosis

I'm curious, what dosage of Advair did your Pulmonologist begin you on?

I used 500/50 for years to keep my CVA under control. Finally able to go to 250/50 in January. Would someday like to go even lower to the 100/50.

Many of my PFT's came back normal, even when my asthma was bad. It was frustrating, but my Pulmonologist was very thorough and didn't go by them alone in determining my treatment.

 
Old 06-25-2009, 10:17 PM   #12
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Re: Possible CVA Diagnosis

MountainReader,
I'm on the 250/50 dose. A funny thing is happening. I've had two coughing fits (aka: asthma attacks) today, but the chronic coughing here and there is getting better. In other words, the delineations between true attacks and the constant coughing is getting clearer. I hope that means that the Advair is starting to work and the chronic coughing will go first, with the true asthma episodes to follow after that.

Would you mind telling me how long it took Advair to get your symptoms totally under control? Should I expect good results in a week, two weeks, if this is truly asthma?
Thanks.

 
Old 06-26-2009, 05:46 PM   #13
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Re: Possible CVA Diagnosis

kfcarroll,
It has been a few years since I went on the Advair. I'm not sure how long it took for the Advair to take effect because I was using my Albuterol frequently and was also on some Prednisone for a couple weeks at the same time. My asthma was pretty bad by the time I was diagnosed. Prior to this, they kept diagnosing my cough as a side effect of my sinus infections. I do know that at the time, the combination of steroids and Advair did get things under control within a week or two. I was even on a lower dose back then. I'd had trouble for weeks before I was actually diagnosed with asthma officially and put on the Advair. I've been happy with its use since around 2002 though. I remember coughing like crazy as I volunteered at the winter Olympics and was stationed in cold air that was triggering my asthma. I never realized my cough was asthma prior to then.

I hope the Advair works quickly for you. It did help me keep things under control for years. Unfortunately, I had asthma out of control a bit over a year ago because I had a "new" trigger and it took a while to get the cause back under control. Still onthe Advair though.

Has your doctor given you a written asthma plan yet?

 
Old 06-28-2009, 06:13 PM   #14
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Re: Possible CVA Diagnosis

MountainReader,
it's really helpful talking to you about this! Our stories sound quite similar. I've had symptoms for 20 years (coughing in cold air, for example), that I thought were just normal. It's only because this cough became so accute that I had to find some relief and finally staggered back into my doc's office.

The Advair seems to be working. I've been on it five days, and i've noticed that I'm coughing less (but I'm definitely still coughing) and the cough when it does happen is less vicious. Also, the rescue inhaler (Proventil HFA) is having more of an effect, so I'm guessing all this means that the Advair is slowing calming down the inflammation enough for the Proventil to have some effect. When I go through a whole day without needing the rescue inhaler, I'll know the Advair has taken hold.

No asthma management plan yet. I still have to do some the PFTs and some other tests. Doc said that my PFTs will probably be normal but he can make the diagnosis if the Advair works. Then i'm sure we'll talk plans.

What's your action plan? Do you have e any recommendations in setting one up?

Oh, someone told me today that I should look up sarcoidosis because a friend of hers with a chronic cough had that. I did, and it said that usually the nodules show up in the chest x-rays, but mine were normal.
Best,
karen

 
Old 06-28-2009, 11:14 PM   #15
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Re: Possible CVA Diagnosis

Karen,
Glad to hear you are doing a bit better. It is really uncomfortable, frustrating and scary when the coughing is bad and things aren't working to get it under control.

I was treated successfully by a good PCP for years. When she left the practice, I couldn't find another supportive doctor. Even when I went to one with an emergency asthma attack, he just gave me an epi shot to get things under control, a prescription for steroids and sent me on my way. I knew then that I had to be aggressive in getting control back. I self-referred to a recommended Pulmonologist. I knew something was wrong because my original treatment of Advair 500/50, Singulair and Albuterol had stopped being effective after years of working very well. None of the new docs I went to really seemed to care.

Do you know which other tests you will be having?

When I first went to my Pulmonologist last year, he had me do a couple PFT tests, a TB test, a chest x-ray- 3rd that year, a Modified Barium Swallow and an Esophagram. The Barium testing came back that in addition to my environmental asthma triggers I also had acid reflux triggering my asthma. (Cough my only symptom for both.) Later I also ended up getting second endoscopies, 24 hr pH's and Manometries.

I was worried the Pulmonologist would basically blow me off with regards to the severity of my asthma because the breathing tests were normal. He didn't though. He spent 45 minutes asking me questions on my first visit and 30 minutes on each of my follow-up visits. He put me on an asthma action plan during our first meeting. He reviewed and tweaked the plan on my last two visits. It was his really listening to me that lead to the eventual diagnosis of my second asthma trigger and to my GI follow-up. It was originally my Pulmonologist, not my GI doc, that recognised how severe my reflux actually was. In fact he recommended the reflux surgery that I eventually ended up having.

Here is a link to a good asthma action plan. It is the standard format recommended by the EPA and provides a good framework for developing your own. My personal plan actually follows this general format as well. If you search, you will find that most state health departments also have a version of this on their websites.

http://www.epa.gov/asthma/pdfs/asthma_action_plan.pdf

Asthma plans are an individual thing. I think mine follows the basic format, but is a bit more aggressive than some and allows for more self-treatment than many. My personal plan is basically as follows:

*Monitor my peak flow on my own at home. More often when my asthma symptoms are flaring. Treat as prescribed when I notice symptoms. (I've done this, but I really have gotten to know my body well so I can usually predict a pending attack before it is reflected in the peak flow. See my posts on Asthma Early Warning Signs.)
*Avoid asthma triggers where possible. (I wear a scarf or mask during all cold weather when I'm out and about. I try to avoid chemical triggers. I treat my reflux. It's hard to avoid the major air pollutions at times though.)
*Exercise more.
*Get a yearly flu shot. (They also recommend a yearly Pneumococcal vaccine, but I'm allergic to the horse serum they use for that one.)
*Watch for signs of infection and treat immediately.
*Treat with Medication. (I've build some good trust and relialibility with my Pulmonologist. In addition to my daily regimine of Advair 250/50, Singulair, Albuterol (as needed) and carrying an Epi-pen, he has given me a standing prescriptions for when things get worse of Advair 500/50, oral steroids, Tessalon Perle, and antibiotics so that I can self-treat when things get bad without waiting for an appointment.)

My plan of when and how to treat:
Monitor for severity.

Green: Basically, I continue with my daily regimine and carry my rescue inhaler and Epi-pen for emergency. Watch out for potential triggers and avoid as possible. I might use my rescue inhaler rarely during this time. Typically for me, it is when I run across an environmental trigger that I'm not around for long.

Yellow: I'm seeing frequent symptoms and need to begin further treatment. Typically I may have days or weeks where I use my rescue inhaler more often. I would up my Advair to 500/50. If it continues or is really bad, I would begin on a tapering dose of Prednisone. If I saw signs of infection, I'd also add antibiotics as well. With my CVA, my symptom here is a chronic cough. Occassionally I'll get some chest 'tightness' or shortness of breath. I get in this zone with bad reflux, during inversions or heavy pollution days that last for days on end, or when there is very cold winter air. Sinus infections also trigger this for me sometimes. In the past, I often ended up at the doctor's at least once per flare when I'm in this zone. I hope with my revised plan and the standing prescriptions that I can get things under control with fewer doctor's visits.

Red: Get emergency treatment! Go to an ER immediately or call for an ambulance. By this time, I've tried my rescue inhaler with little or no effect. Up til recently, I've been able to avoid this zone. I had my first Red Zone day a little over a year ago. Despite the use of my Albuterol, I suddenly couldn't get a good breath. My breathing became really shallow and eventually I couldn't speak two words in a row. By the time I was administered my emergency medical treatment, I had numb, tingling, purple lips and fingertips. I became lightheaded and I was hyperventilating. It is very scary not being able to get air in. They gave me a shot of epinephren that helped get my airways open. I now carry an Epi-pen to use in a bad attack to give me some time for the emergency help to arrive. They will typically provide other breathing treatments at this stage as well.

Many people have the use of a nebulizer as part of their asthma plan. They are often used in the Yellow Zone. At this point, my docs feel I am using my inhalers effectively and have not prescribed one for me.

Working closely with my Pulmonologist, GI doc and ENT, I've been mostly cough free for months now. Just a couple small environmental triggers that Albuterol quickly brought under control. I now have my reflux under control and my treatments for the environmental stuff has been working.

I do have allergies, but haven't had allergic triggered asthma in the past. Mostly it is when the allergies affect the sinuses and my sinus infection triggers the asthma. I'm 1 1/2 years into my second round of immunotherapy and I'm finding it successful. I recently went off of 2 of my 4 allergy medications as well.

I know this was really long. I hope you found it useful.

 
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