Expert: Marc Rubin, RPh Asthma Educator - 8/31/2011

Question
QUESTION: Hi March Rubin, this started about july 18th.

-It started with: a throat tickle/dryness & became a sore throat. Fatigue like you have when you have a cold/flu.

-Turned to: sore throat diminished over time, but then developed a cough & this weird feeling in my chest

-There were NO: fever, chills or runny nose

-First doctor visit: he said he didnt want to give antibiotics right away
-Second doctor visit: he said allergies & asthma (given inhalers) (I have a history of childhood asthma)

-Since I have been given the inhalers, I noticed the cough improved a lot, and went to the doctors afterwards for more follow ups, he listened to my back & said it was clearing up but keep the inhalers in case the cough comes back. I also asked for a general blood test & urine test, but I didnt get called back since Im assuming it was ok.

-I get worried when it comes to health issues, so I went to a std/hiv clinic for rapid insti hiv test, it was negative.

-Since this whole thing started, I noticed my chest hasnt felt the same since, and I have been spitting up phlegm sometimes, usually after waking up.

-Any thoughts or ideas? Can this be something other than allergies & asthma? Are there certain tests that I can do to confirm this? Thank you.

(Vancouver BC, suburban area, no pets, occasionally taking ventolin  & advair (taking as doctor said, but now ventolin just before exercise, advair occasionally)

ANSWER: Hi,

Sorry for the delay....

This time of year is the worst for asthmatics due to mold and ragweed. The tests that should be done to properly evaluate you are:
1) Complete blood count with differential (CBC + Diff): looking at the eosinophil levels. This is the specific white blood cell cell that increases in times of allergic attack.
2) Spirometry: a breathing test using a computer. Sometimes a portable hand-held unit of larger with a breathing tube attached. This is best performed in the office of an allergist or pulmonologist due to the proper technique is critical to get accurate results. If not executed correctly, the results are meaningless.

The increase in sputum would be a marker of asthma flare, since asthmatics have a greater number of cells which produce mucus, specifically goblet cells, where the mucus is more like thicker plugs.

Advair is a "controller" medication that needs to be taken every 12 hours EVERY day. It has two medications in it: a long-acting version of Ventolin to keep your lungs open, and more critically, a steroid to reduce the tissue inflammation in the airways. It takes ~ 1 month of continuous use for the steroid to begin getting the inflammation under control, and a full 6 months to achieve maximum benefit. If you are  showing improvement after a couple of months, you may be reduced down to the inhalation steroid only, with the Ventolin for as needed rescue relief.

I'd also advise you to get a "Peak Flow Meter". It is an inexpensive device ($20-$30) that allows you to evaluate how you are doing.

For a proper, complete evaluation, I'd get into a specialist, preferable an allergist, to assess your status. Patients with asthma who have not required meds in some time frequently underestimate how their lung function has decreased. Their acceptance of "normal function" may actually be 20-30% below what it should be. Once under control again, you'll sleep better, have more energy, and...perform in your sports activities to a higher level. Overall, you'll enjoy a higher quality of life.

If you have further questions, feel free to get back to me.

Sincerely,

Marc

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

QUESTION: Hi Marc, thank you for your reply.

-I will go to see a doctor asap & ask for the cdc with diff (im not sure if this was done in the blood test I asked for, but I do remember seeing the box checked for 'hematology profile', ferretin, suspected hypothyroidism, microscopic dip of urine)
-I will also ask for an appointment with the allergist, though I think it will take a month or so to get it

-I have not been consistent with the advair since I read it can increase the risk of catching an upper respiratory infection? I also wasnt sure how long or even if I needed it, I thought taking medication without needing it could be bad. But, I will be more consistent now.   

I have been noticing as a usual event that: I have been waking up with dry lips/mouth/throat, my throat feels dry and a bit sore even when I awake and somewhat through the day, most of the mucous has been in the mornings. My nose has diminished smell since I couldnt smell the paint yesterday my brother & dad were talking about even when I was outside, until I really tried to smell it.

My follow up question is if you know if allergies causes this whole thing of dry lips/mouth/throat and even making the throat feel sore? (Since I have been having this and am not sure what is going on)  Thank you.

Answer
Hi H,

Sorry for the delayed response. (Just finished 30 days straight of 12 hr overnights with 24 nights more to go.)

The sore throat is probably due to post-nasal drip caused by allergies. Of concern is the loss of smell. The condition is called anosmia, and it is sometimes caused by a viral infection. It also has been caused by a cold product that has been taken off the market called Zincam Nasal Spray. Often the sense of smell returns, but sometimes it is permanent. I know of someone who had it and had seen the top people in the country about it. Finally reversed with acupuncture after all traditional western medicine methods failed. Note, zinc lozenges can also cause the dry throat condition. Are you taking any over the counter (non-prescription) meds?

Marc