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QUESTION: hey its me again
i went to doc yesterday as my cough and tight chest was really really bad especially half hour after my alburtarol treatment at home... wheezing sounds like crazy.

I decided as well as the DOC did to take the steroid combo shot of DepoMethdrol / Decadron

He also prescribed me Prednisone and Antibiotics (CEPHALEXIN)

he felt it was needed to add the prednisone to really knock this out and i think ill go for that. I use my voice for a living and really need to get better LIKE NOW.

As for the antibiotics, what was weird is that i told you for the past week sputnum was clear .. well today i coughed up some yellow chunks when i went to the bathroom before my checkup and i save one of those chunks to show him ... but even though im not feverish and feel fine he thought it best to take them.
Ive done shots before and all was well ... ive done antibiotics although its been Yeeeeeeeears and i usually take care of myself with probiotics regiment after the treatment and take Calcium Vitamin D when taking prednisone.

Well its 13 hours since the steroid shot and i can breath freely and my chest is open and not tight ... But post nasal still comes and goes even though my nose seems clear and i can breath and occasional cough ..

Would like your thoughts on the shot/prednisone/antibiotics
and also what i should take to best control allergies, like clariten or allegra etc...

ANSWER: Hi Joe,
  Glad to see that you went to the physician. In today's practice, the justification for injection, under these circumstances, is when the person is not able to keep down food or fluids. The oral prednisone should have sufficed. If you indeed him asthma, something you should further investigate, antibiotic of choice is azithromycin. This is because there are two bacteria that actually trigger asthma problems. And they are both treated with azithromycin.
 Regarding best antihistamine approach, I prefer to start with Allegra (the generic is fine). It's a once a day, nondrowsy formula. It does not help 100% of the population though. It's a great starting point, but if it fails, I would then try Zyrtec (also the generic). If either one gives you relieve, but not total clearing of the sinuses, then I'd speak to the doctor about a nasal spray that you would  a daily basis. The most common one is fluticasone.
  Let me know how this goes for you.

Sincerely,

Marc

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

QUESTION: i think because i was really bad i wanted the injection and did not want to wait ... if i had gone earlier in the week then maybe but i was really bad and somewhat concerned and i never get concerned but what done is done so i thought the shot would be the fastest way to relief.

*WHAT ARE YOUR THOUGHTS THAT IM ALSO GONNA BE TAKING THE PREDNISONE ?
ive done the shot and prednisone before yeeeears ago when i was bad.

HOW SOON DOES PREDNISONE KICK IN AS COMPARED TO THE SHOT (curious)

Should i call the Doc and mention the Azithromycin
or just stick with the CEPHALEXIN
Why would CEPHALEXIN be prescribed? Is it cheaper choice?
Is it at least gonna help?

In regards to Allegra and Zyrtec are you talking about the "D" version
or just the regular one without the decongestant?

Oh i also do have a bottle of Fluticasone at home
and i also Nasonex ... which is better or are they different ?

Answer
Hi Joe,
 Kenalog is 8-10 hours peak levels vs. 2 for pred. One shot of Kenalog is cleared from the system in five days. Prednisone is cleared and 20 hours. Much less likely to suppress the body's normal function of reducing inflammation.
 I generally recommend on the antihistamines, start with the non-decongestant form.
 Regarding the antibiotics, if there's no improvement in 3 to 4 days, then I would follow up with the doctor. It may mean it is a viral infection, in which case there isn't an antibiotic to use, or it might be best to change to the azithromycin.
 No real preference concerning the nasal sprays. Proper technique though it is important. First check to make sure it is still in date. Then, shake the nose spray gently. Blow your nose gently. Prime the nose spray 3 to 5 times to get a fine mist. Then, having the nasal spray pointed towards the flare of the nostril, spray the medication. It should not be sprayed straight up into the sinuses. Sniff gently, then spray the other nostril. Initially, you may want to do twice a day with your nostrils, or two sprays each side, for the first few days until things improve. Then you can reduced to a single spray and each side once today.

Hopes this helps! :-)

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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