Expert: Marc Rubin, RPh Asthma Educator - 4/20/2010

Question
QUESTION: I have had for the past 6 months on and off a persistent cough(sometimes dry) and sinus congestion.  I twice went unconscious and routinely get lightheaded during coughing.  I haven't slept well in weeks.  I am on an inhaler (advair 100/50) and a nasal inhaler (nasonex).  I have been taking singulair for 1 1/2 months.  I have high blood pressure and take benicar and felodipine daily (115/85avg.). I have visited a allergist to found me allergic to numerous grasses, pollens, and dusts.  We took the carpet out or the house, I have purchased a plastic mattress cover and pillow covers.  I use a nasal rinse and when needed a rescue inhaler.  Been to my PCP 6 times, receiving predisone and various anti-biotics (which both work until they run out).  Went to an ENT who states I have a large tongue and swollen tonsils, but said there is no action he can take to resolve issue. Recently been using oxygen borrowed from a neighbor.  I have an appointment with a pulmonologist in 1 1/12 weeks.  I haven't been to the emergency room, but he last couple of nights (and days) were rough and I gave it thought.  I have been though the internet and read lots about asthma, coronary artery disease and heart failure.  I don't have fever and ox test has consistently been 95%.  spriometry showed low before predisone but was outstanding with predisone.  Please help

ANSWER: Hi Larry,

Are you Caucasian? If not, what race? It can be a determinant for drug resistance.

Do you use albuterol (Ventolin HFA, Pro-Air HFA, Proventil HFA or Xopenex HFA), and does it work well, sort of, poorly?

At what age did you remember developing asthma?

How old is your home? Do you have a basement? Has your home been checked for mold?

Where specifically do you live: state, city/rural?

Any pets in the home?

If rural, near any farms with livestock?

What is your occupation? There are specific allergic triggers associated with certain jobs.

Do you have any food allergies? If so, please list them.

I'll be out for a good part of the day, and will try to check back this evening for your response.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: MArc,

Thanks so much for responding.

I am caucasian
Yes, -sort of
46
1976 - no basement, no signs of mold (live in Florida)
Florida - Sarasota COunty surburban
No pets (had a cat and a dog)
No local livestock
I do monitor the landfill by collecting groundwater - around grasses, however, the problem preceded this job.  Prior job was indoors
No food allergies identified by allergist

I was in the Air Force and served for 9 months in southwest Asia (saudi arabia in 1990-1991).  I was given an experimental shot for protection against anthrax, was denied opportunity by red cross to give bllod after the shot.

ANSWER: Hi Larry,

I want you to do mold testing in our home. There are kits sold at the hardware store for this, or you may wish to have a firm do this (contact your local health department for referrals). If you do not have an accessible attic space, I'd get a specialist firm. If there is any roof leakage, this could be the source of the problem. Florida with its' high humidity is a natural breeding ground for mold.

Based upon your response regarding albuterol, I'm suggesting you request the doctor to change to Combivent, a mix of albuterol and ipratropium. Some people have a genetic variation that results in less than optimal response with albuterol, and instead get a full response with ipratropium. If you find that the Combivent gives better results, stay with it, or depending on your insurance, change to Atrovent-HFA, which is just the ipratropium compound.

Finally, at least at this point, is something of greater concern: the anthrax vaccine. Here is a link to an article by a physician detailing medical issues created or aggravated by the vaccine. You need to bring this to your specialist:

http://www.ahrp.org/infomail/0702/18.php

Get back to me after MD follow-up.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: i have seen a pulmonlogist who prescribe nebulizer treatment and drew blood to determine if xolair shot would be beneficial.  Today, I have a fever of 101.3.  Should i be concerned enough to go to an emergency room.  Other than a slight chill I really feel better than ihave for some time.

Answer
Hi Larry,

My Blackberry was unable to log into the account last night, which is why I was not able to respond earlier (I'm on overnights).

Viral infections, as well as certain specific bacterial infections can cause a flare-up with asthma. This would explain the fever. I'm assuming that the pulmonologist didn't actually give you the Xolair yet. It is generally reserved for severe asthmatics that are poorly controlled on other regimens. It is also more typically utilized by allergists than pulmonologists. Although Xolair is a terrific drug, it is not without risks, which is why it is generally held for those that are more difficult to get under control. Although infections are seen after beginning Xolair, running am elevated temperature is not noted in the side effects. Regardless, I'd let the physician know.

Sincerely,

Marc