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Old 10-08-2012, 10:15 PM   #1
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Seasonal coughing is back

So, it took me many years, but I finally got my asthma under control and was able to wean off of my multitude of asthma meds. I still follow my asthma action plan though to try to keep the flares at bay. Unfortunately, some extremely nasty air triggered my asthma and chronic cough a few weeks ago. The air eventually cleared, but my cough didn't. I upped my treatment to Advair 500/50 and used my Ventolin regularly. Last week, I even ended up back on a short 5 days of Prednisone. The cough keeps hanging on though.

I know my asthma can be triggered by acid reflux and even upped my acid reflux meds in case all that environmental asthma coughing had triggered my acid reflux issues again. I haven't felt any other symptoms that lead me to believe that the acid is actually causing my main issues right now though.

When I went to my PCP, he pointed out that I have a consistant history of visiting him year after year at this exact time for asthma and coughing problems. He really does think the change of seasons has been a trigger. I really do want to agree with him, but at this point I just know I'm frustrated since my normal treatments aren't getting things back under control.

After 3 weeks of a chronic cough, I'm starting to get the pulled muscles in my side and back. I'm also tired of breathing like I've had a hard workout after just walking down a flight of stairs and having a coughing fit. I do have faith I'll find an answer at some point, but it really does weigh on a person.

Thanks for listening.
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Old 10-09-2012, 12:22 AM   #2
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Re: Seasonal coughing is back

Asthma notoriously flares up in the fall, especially when cold damp weather sets in. In urban settings the pollution tends to worsen in cold weather too. five days of Prednisone is very short, and you may want to talk to your Dr about staying on a low dose a little longer. Even 5mg a day can be helpful for a couple of weeks, with a tapering off. Have you ever been on Singulair? It is a once daily oral med that some people respond very well to, and can be used throughout the winter for maintenance. It may stabilize you enough that you won't have to use the inhalers as much. It might be worth a try. It is not used for acute flares, just a preventive stabilizer. Finding out what environmental inhalants you are allergic to can be very worthwhile so you can avoid as many as possible. If you have not had allergy testing, I would. I like the Blood tests over skin ***** tests for accuracy and determining severity of each allergen reaction. national Jewish Hospital is a great resource for asthmatics. You can talk to a nurse on their Lung Line anytime and ask questions, get info.
Also, an influenza vaccine and pneumonia vaccine are important to prevent infectious triggers of asthma.

 
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Old 10-09-2012, 06:17 PM   #3
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Re: Seasonal coughing is back

Thanks for your response. I didn't give much history in my introduction.

I'm about 4+ years into allergic immunotherapy. (My second go-round.) I'm 2 years into Xolair shots for allergic asthma. Prior to the Xolair, for many years I was on Singulair, Advair 500/50, albuterol (inhaler and nebulizer), Allegra, Flonase and Astelin. With the effectiveness of the Xolair + immnotherapy, I was actually able to gradually step down off of all of the meds over the last year. I have gone back on the Advair as needed over the last year, but usually for a month or two at a time until the triggers are gone. That and the albuterol has worked for me until now. It may be that I need to try adding Singulair again. I'm not sure right now.

My Pulmonologist actually doesn't want me on the Prednisone at all unless my peak flow gets much lower. I've just been struggling so badly with the coughing fits that I agreed to it with my PCP. I called my Pulmonologist and can't get in for an appointment until December 19th. Their office refers me back to my PCP until I can get in. Both my Dr's worry about the steroids on my belly too. My ENT/allergist is willing to do a scope of my throat and switch me from Advair to another tinhaler. I know I could get in to see him in the next few days if I need to.

My worst trigger right now is air quality. Unfortunately, a few weeks ago, we had an inversion of wildfire smoky air set in over our mountain valley for almost a week. That was my trigger this time. The air has cleared out, but my lungs still aren't happy. Winters are my worst time because some years we end up with extended periods of inversions and red air quality. I tend to wear a filtering mask around most of the winter when I'm outside.

My Pulmonologist agrees with you on the vaccines for people with asthma. I've already had my yearly flu shot. I can't get the pneumonia one because I'm allergic to horses.

All very good advice though. Thanks again.
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Last edited by MountainReader; 10-09-2012 at 06:19 PM.

 
Old 10-09-2012, 07:06 PM   #4
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Re: Seasonal coughing is back

I'm sorry that the fires out west affected the air quality in your area. Even though the air has cleared I'm not surprised that your cough has lingered. When I have a bad flare up the cough takes quite a while to settle down. Like you, I have to go on quite a lot of meds. Unlike you, I am on them daily. But I must say that my cough is usually in check so I guess they work. I"m retired so I can avoid my triggers pretty well which also helps. No workers with too much fragance to bother me.
I'm sorry that you are not feeling well. I hope that you feel better soon.

 
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Old 10-10-2012, 08:19 PM   #5
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Re: Seasonal coughing is back

Update: Went to ENT today. Switching from Advair to Dulera. I've been on Advair for years so maybe the change will be helpful. Also got a script for Tessalon Perle to try to help calm the cough. Had a scope of my throat (really irritated) and chest x-ray to check to see if something else is going on. Also started on Avelox just in case. We'll see how things go. I'm keeping my fingers crossed.
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Old 11-11-2012, 09:35 AM   #6
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Re: Seasonal coughing is back

Wow, I'm going into my 10th week of the chronic cough. What was 100% an asthma flare in the beginning has now turned into a cough that refuses to leave. It is driving me crazy and really starting to wear me down.

I've gone from no asthma meds and only taking Dexilant once a day to: A round of prednisone, ventolin (used more frequently in the beginning of the cough), Dulera (replacing Advair 500/50 which I took for a month), singulair, a round of Avelox, a round of Biaxin (currently on this one), Dexilant twice a day, and Tessalon Perle. Still no luck.

I can go short periods now with no coughing, but then when it hits, it hits hard. To make matters worse, the cold winter air has returned along with the snow. The cold air is one of my worst triggers for asthma.

It is so frustrating since I had full control of my asthma for so long and I've followed my asthma action plan so closely and still I have problems.

I called 6 weeks ago to get a Pulmonogist appointment and can't get in until mid December. I keep calling about cancellations and so far, no luck. I've seen my PCP a couple times, my ENT (who did a scope and chest x-ray and upped my meds) and my Gastroenterologist (who said it had been 2 years since my last upper endoscopy so I'm going to be getting another one).

I'm not sure what else I should be doing at this point.

To top it off, I have surgery on my hand and wrist next week. My PCP cleared me, but I had hoped I'd have this solved by now.
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Old 11-18-2012, 03:48 AM   #7
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Re: Seasonal coughing is back

Hi Mountainreader.
I am sorry to hear that you are having problems. I hope your coughing has settled some. I know what you mean about the cold affecting your asthma.
I find the cold weather and the temperature change during the day hard on my lungs along with the daily changes. It has been fairly mild here in the day but it
starts off cold.
I hope things get resolved for you because I have followed your posts and I know you said things have been better since xolair.
I hope you can reduce your medications soon.
I have not been able to reduce any medication except not nearly as much prednisone since starting xolair last year. The other thing that has decreased is the emergency visits and the admissions to hospital.

Good luck.

Last edited by klynn1960; 11-18-2012 at 03:48 AM.

 
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Old 11-18-2012, 01:46 PM   #8
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Re: Seasonal coughing is back

Thanks klynn,

The treatments I'm currently under used to be the norm for me, not just for when I'm having a flare. Despite some frustration during the occassional flare, I'm still really happy with the Xolair. I'm in a much better place overall than I was a couple years ago.

My cough is slowly improving. I'm going longer between coughing each day. It could be helping that our temperatures here have gone back up into the 50's. I also finished the antibiotics. Not sure how much impact they had. I've also doubled my acid reflux meds at the same time. It could be any or all of the items helping. That or just time. My flares of coughing usually go in 3-4 month cycles.

Hopefully I'll be good to go for my surgery Tuesday.

I'll keep you posted on my progress coming up.

Also, I've found a couple face masks that I've worn out during the winters the last couple years. They work much better than scarves because they mold to the face better. Having them warm the air first keeps the cold from being quite as harsh on my lungs.

Glad to hear you have had fewer hospital visits. Every little step is huge progress when things get that bad.
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Old 11-19-2012, 02:47 PM   #9
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Re: Seasonal coughing is back

Hi Mountainreader
I just wanted to say I hope your surgery goes well.

You are so right about the xolair any reduction in medication or hospital admissions from asthma make it worthwhile taking it.

Let us know how things go.

 
Old 12-19-2012, 08:13 PM   #10
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Re: Seasonal coughing is back

I'm sitting here really frustrated with this Chronic Chough. I think I'm now on week 16 of this flare. It started as a pure asthma attack when cold smoky air settled in for a week. I got my lungs sounding better, but my cough has hung in. It isn't as intense as it was and I now have some periods of time without coughing that I didn't have before, so I guess that is good.

I had an appointment with my Pulmonologist today. This was the first appointment I could get when I called back in September. He actually spent about 45 minutes with me. He basically said that I know my cough is triggered by allergies, sinuses, asthma, and reflux. He said as long as my peak flow was doing well that I should focus on areas other than the asthma. This frustrates me as the cold air now triggers coughing attacks. He said to stay on the amped up meds that I've been taking for my reflux. I'm on lots of shots for the allergy stuff now already. Basically, I left with no new treatments and a reminder to keep doing what I already am. I really just want to get rid of this cough. He does want to see me from now on in 3 month increments so at least he isn't giving up on me though. I know I'm doing a lot of things "right" but when they don't fully take care of the problem it really really becomes frustrating.

I did have an upper endoscopy and 24 hr pH test a couple weeks ago. They both came back normal this time. YEA!! I've had severe reflux issues for year with the gaseous reflux irritating my lungs. My Pulmonologist basically said that we both know I still have reflux issues and to stay on the Dexilant and Zantac so my asthma doesn't get worse, despite the normal pH testing. I know he is right, but again, it is frustrating.

Based upon conversations today, I do think I'll do a repeat overnight sleep study. I had one a couple years ago when I was wearing a custom sleep splint and it came back OK. I'm no longer able to wear the splint since I'm in orthodontic braces for TMJD. I did have an overnight oxygen test several years ago that came back abnormal which was why I had the first sleep study, but I wasn't wearing my sleep splint at that time. I'm not totally sure of the value, but at this point I'm open to looking for other things impacting my health. Any thoughts?

By the way, my surgery went well. I'm a month out and in PT. I'm very hopeful to regain full ROM in my wrist. I haven't had that since my surgery last February.
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Last edited by MountainReader; 12-19-2012 at 08:16 PM.

 
Old 12-19-2012, 08:36 PM   #11
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Re: Seasonal coughing is back

I'm so sorry to hear you are still having problems. I was so jealous back in the summer when you told me you were off all your asthma meds! I hope things get back to normal for you soon.

 
Old 12-19-2012, 09:51 PM   #12
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Re: Seasonal coughing is back

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Originally Posted by MeezerWheezer View Post
I'm so sorry to hear you are still having problems. I was so jealous back in the summer when you told me you were off all your asthma meds! I hope things get back to normal for you soon.
Thanks. I was so bummed when the cough returned. I made it about 9 months off of the asthma meds. That was pretty incredible for me. I guess we always know it just takes one thing to trigger an asthma flare, even when we are doing everything we should. It is just frustrating.

I appreciate your well wishes.
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Old 12-20-2012, 08:18 AM   #13
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Re: Seasonal coughing is back

I will just offer up what I can: I have switched from albuterol inhalers to Xopenex, which I love because it doesn't cause the shaky, jittery feeling at all. I am a believer in inhaled steroids along with Singular. The mask to warm the air you breathe is a good idea. Also for very short sprints like going from house to car in cold, just cover your nose and mouth with your hands and breathe thru nose-it warms the air better than mouth. Do everything you can to find out what allergies you have and eliminate what you can from environment. National Jewish Hospital in Denver has wonderful resources on everything related to asthma, many available online or by phone, including talking to an asthma specialist nurse, all free of charge. Have you considered moving to a warmer, dry climate? If the problem is severe, may be a valid consideration.

 
Old 12-20-2012, 11:29 AM   #14
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Re: Seasonal coughing is back

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Originally Posted by MountainReader View Post
Thanks. I was so bummed when the cough returned. I made it about 9 months off of the asthma meds. That was pretty incredible for me. I guess we always know it just takes one thing to trigger an asthma flare, even when we are doing everything we should. It is just frustrating.

I appreciate your well wishes.
I understand, asthma is such a fickle disease. I had a really good Spring/Summer but had a more challenging Fall. I also got pulled off the allergy shots because I kept getting hives and my new Allergist wasn't comfortable proceeding. Guess I'll just have to deal with the allergies then!

 
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Old 12-20-2012, 02:24 PM   #15
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Re: Seasonal coughing is back

Quote:
Originally Posted by MountainReader View Post
Thanks. I was so bummed when the cough returned. I made it about 9 months off of the asthma meds. That was pretty incredible for me. I guess we always know it just takes one thing to trigger an asthma flare, even when we are doing everything we should. It is just frustrating.

I appreciate your well wishes.
Hi,
I hope you can get off your asthma meds again. You are so right about it
just taking on thing to flare the asthma.
I hope things get better for you soon.

 
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