Expert: Marc Rubin, RPh Asthma Educator - 11/2/2008

Question
Hello,
I've had exercised induced asthma since I was 12 (I'm currently 23), and generally used albuterol to alleviate any discomfort when engaging in vigorous activity (I'm very active and exercise 4-5 times a week). Over the past couple years, I've seen a notable decrease in symptoms, to the point of not even using a rescue inhaler 90% of the time.

Two weeks ago I came down with a bad cold, which developed into a chest cold. My doctor prescribed antibiotics because we both feared it was developing into a bacterial infection. My energy level came back, but my coughing and wheezing got progressively worse. A second visit to the doctor resulted in being prescribed Symbicort, which I've been using for 3 days now. This has reduced the frequency of my coughing and shortness of breath, but not their intensity when they occur. I'm worried that my asthma symptoms are returning to be much worse than they ever have been before. Could this recent illness have triggered a permanent change in my asthma symptoms, or does this seem more like a transitional period during the road to recovery?

Answer
Hi Julius,

One of the greatest triggers for asthma are viral infections, not bacterial. I'm not surprised of the worsening of symptoms, since you probably had a significant increase in inflammation in your lungs due to the viral infection. This is why patients with pulmonary conditions such as asthma, emphysema, COPD and chronic bronchitis need to get flu shots.

I hope that your physician did a blood test to see if your white count was elevated, as it would be in an infection, before prescribing the antibiotic. Only two bacteria actually affect asthmatics adversely, and they are: Chlamydia pneumonia and Mycoplasma pneumonia. If the doctor is concerned about you being at risk for infection, he should use an antibiotic that would cover these two possibilities.

I would not expect that this is nothing more than a flare-up, not a permanent change. I would continue on the Symbicort through this winter season to reduce the inflammation back down in your lungs (the steroid component really reaches its' maximum benefit at 6 months, and most of the relief you are seeing is from the long-acting bronchodilator component of the medication). This way, since we haven't even reached the worst part of the year for viruses, your lungs will be in better shape to deal with it, and a subsequent attack may not be as severe.

I hope this helps you. If you have further questions, please get back to me.

Thanks!

Sincerely,

Marc