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Asthma/POSSIBLE ASTHMA - COUGH 3 WEEKS

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QUESTION: I HAVE HISTORY OF:

nasal issues like allergies, sinusitis, polyps yeeeears ago.
ive had steroid shots before (i do my best not to get them)
my combo shot of choice has been Kenalog/Decodron (works great)
ive done NASONEX, FLUTICASONE (i still have samples of both
one cat at home, had cats all my life ... i dont think they are triggers as ive been fine for years and no issues ... live in Dallas TX.

about 3 weeks ago started post nasal drip, cough, stuffiness, phlegm coming out, but felt fine. NO FEVER, NO ACHES
.. all good so far.

Week later woke up to tight chest feeling along with the cough but seem like nothing would come up although i never felt like phlegm needed to come out ... this just came out of nowhere and nothing different took place around me ... Coughing continued and I did a breathing treatment of Albuterol at home as my sister has the machine and meds ... Ive done this before ... the treatment did give me relief from the tight chest feeling but hour later seem to cough more and that lasted long time ... I did another treatment the next day and again seem to make me cough more after hour of treatment.

Ive also taken Mucinex, decongestants, allegra but the post nasal continues after relief ... MY COUGH sometimes dry and sometimes phlegm .. but mostly its just clear liquid with some slight blood, i think? .. FYI during this whole ordeal i feel fine, meaning no fever, cold, flu like anything. I feel great just tired from the coughing ... Yeah i lost my voice from all the coughing and have some of that back but still hoarse ...

Ive put off going to the DOC cuz i feel i dont have infection, and ive heard that a cough can last long time with no real issues

Im wondering what i should do next, i mean would a steroid shot help all that i have going on?

the nearest place to go does give combo shots but they do not use Kenalog ...
they use DECADRON/DEPO MEDROL (whats your thoughts o that combo?

oh I also take PRIMATENE tablet which contains Guaifenesin and Ephedra ... Im ok taking ephedra for one ive taken it many times before and im ok, its only 12.5 each tablet and iv taken 2 many times ... taking these really give my chest relief

ANSWER: Hi Joe,
  Without any recent documented medical history, offhand it sounds like a viral bronchitis. Low or no fever, some productive cough with clear phlegm, recent onset (you'd have chronic issues if it was from the cats).
 I would follow up with your doctor to verify this. The best treatment, it's actually using some asthma medication, such as Advair, Symbicort or Dulera for 1 month. It will keep your airways open, and reduce the inflammation from both the infection and the cough
  Bronchitis come last 4 to 6 weeks, so this probably be able to get you completely through it. But, you really need to see a doctor for full work up. There is a saying, all that wheezes is not necessarily asthma.
  Hope this helps to guide you.

  Sincerely,

Marc

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

QUESTION: thanks for the quick response

... given a choice which is better/safer: Advair, Symbicort or Dulera?

and are they all in the class of "STEROIDS"???
... Are these better than the "shot" because its more localized ?

Are antibiotics only given if its bacterial or would they be prescribed as well in a VIRAL

Answer
Hi Joe,
 Regarding the three inhalation drugs, all have a combination of a steroid plus a long-acting bronchodilator. The onset of action for Dulera and for Symbicort is about five minutes to open up the airwaves, compared to Advair that takes about half an hour. This is a very minor advantage of the two. Really have to look it which drug is the preferred drug by your insurance company. That can have a huge difference in how much it will cost you.
  Inhalation steroids are best in many cases because it directly attacks the problem. It doesn't have the effect on the entire body which can be detrimental to a patient. However, in very severe cases, is it appropriate to use oral or injectable steroid.
  In regards to the antibiotic, bronchitis guidelines call for not using an antibiotic unless it is proven that there is an infection present. 90% of the cases are caused by a virus, therefore antibiotics should not be used for the majority of these patients. If the sputum that you coughed up was yellowish and greenish, that would be more indicative of the probability of bacterial infection, and therefore the doctor may go ahead and prescribe an antibiotic. But you stated that your sputum was clear, therefore highly unlikely that it is a virus.
 Hope this further helps you.

 Sincerely,

  Marc

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Marc Rubin, RPh Asthma Educator

Expertise

I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.

Experience

Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

Organizations
American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

Publications
AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

Education/Credentials
BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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