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sir-tainly 03-02-2008 03:35 PM

Increased coughing with mucus from intramuscular cortocosteroid for sinusitis?
[B]Question[/B]: Can an intramuscular corticosteroid increase productive bronchial coughing?

[B]History (background)[/B]: I am a 46 year old male. I quit smoking 12 years ago after accruing about 8 pack years between the ages of 22 and 34. As a child I had severe pollen allergies (the kind that would put me in bed for two days), but I 'grew out of them' in my 20s. I only took antihistamines as a child.

[B]History (recent)[/B]: About 7 years ago I moved from Europe to Southern California, then to Northern California. Almost immediately, I began to wheeze and was told by various doctors that I did - or did not - have Asthma! An allergy panel confirmed high sensitivity to many plants and to a lesser extent, cats. In the past 6 years, I have had recurrent Sinusitis that has lasted as long as two months. It almost always ends with a profound cough - enough to tear muscles in my chest.

Four years ago, my wife and I had twins, and I was suddenly exposed to many acquired infections (and sleep deprivation) which would take the usual course of fever, congestion, sinusitis, slow recovery. Antibiotics were often prescribed (Levaquin, Augmentin), though usually fairly short doses.

In late 2005 I developed a sense of "air hunger" which one doctor said was due to asthma, and another said was due to anxiety. I saw a noted pulmonary doctor who gave me a full PFT which disclosed mild asthma and was prescribed Albuterol and Advair. (I also take Prevacid for chronic acid reflux). The asthma medications help a little, so anxiety may also be playing a role in my being constantly conscious of my breathing and sometimes having the sensation of not getting a full breath.

I have maintained annual physicals, which are always normal, the most recent being 1 moth ago. I have had my oxygen stats checked fairly regularly as a part of these respiratory issues, and the numbers always come in betwen 98% and !00%.

[B]Recent:[/B] At Thanksgiving 2007 I acquired what appeared to be a head cold or flu from one of my children. Fever was high and last four days. My head became severely congested and stayed that way. Eventually, before Christmas, I saw my doctor who put me on Levaquin (again) and decongestants, and instructed steam therapy to relieve the congestion. It didn't work.

Two weeks later (between Christmas and New Years) I went to the local urgent care clinic with severe sinusitis symptoms (facial pressure, aching teeth, fatigue), plus the added bonus of bronchitis (diagnosed by history, symptoms and physical examination.) The doctor was "50/50" about giving me a chest x-ray because he did not see evidence of pneumonia. Antibiotics, Mucinex, narcotic cough syrup, steam therapy and being told to return to my asthma meds were prescribed. I coughed profoundly for about two weeks with lots of mucus production. I could hear gurgling way down at the bottom of my lungs, especially when lying down, during this time. Eventually the bronchitis resolved, along with the coughing, but the sinusitis did not.

I took myself to a local noted ENT specialist after all this, suspecting that my chronic sinusitis was the culprit. After his examination, he sent me for a sinus CT scan which confirmed severe sinusitis, chronic because of its duration.

His first approach was to have me try Clarinex-D for a month, with steam therapy. He gave me nasal corticosteroids to start if I felt I needed them. After 3 weeks with just the Clarinex, I was no better, so I began the nasal corticosteroids for a week before my follow-up visit with him. The nasal spray returned my sense of smell and noticeably relieved nasal congestion.

During my follow up, the ENT doctor noted that the nasal spray doesn't go very far into the outer reaches of the sinuses. He was concerned because the congestion was pretty bad around my eyes, leading to mild eye infections, and my ears, leading to blockage which interfered with my ability to fly (which I do a lot for my business).

So, during that visit, he gave me intramuscular corticosteroid in my arm which he advised me would be systemic and deal with inflammation everywhere, including having a positive impact on my Asthma. About two days after the injection (which was a week ago) I began to cough more. The coughing produced fairly sizable chunks of mostly white mucus from my bronchus, not my throat. It is not constant, like Bronchitis, but happens about ten-twelve times a day. It is not serious enough for the narcotic cough syrup, and I don't cough at night.

[B]So, getting back to my original question, is there a correlation between intramuscular corticosteroids and increased bronchial cough?[/B]

I have two theories: first, the decrease in inflammation in my lungs is dislodging impacted mucus which I am expectorating; or second, the significant improvement in my sinuses is causing a lot of draining, some of which is going into my throat and some of which is going into my bronchus causing me to cough.

I certainly feel a lot better over all, but this occasional productive cough is bugging me and I wondering if it will resolve once my sinus drainage balances out, or once I have finally cleared my bronchus. I have no fever or other symptoms. Should I return to have it evaluated and rule out Bronchitis? Or just see how it goes.

I am very interested to hear about the experiences of people who have had systemic corticosteroids for chronic sinusitis.

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