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Asthma/symptoms came back-BRONCHITIS


Bronchial Cast
Bronchial Cast  
hello, i sent you a question couple days ago and never received the ALL EXPERTS TICKET RESPONSE EMAIL and so I dont know if you got it so I apologize if you did since im gonna repeat it here.


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


Well after going to the doc the first time and being given Cephalaxin and Prednisone for 10 days things got better BUT
just one day after finishing cough came back ... then tight chest came back ... pretty much same thing again but yellow and green stringy things started coming out when i hard core cough ... now they come out little easier but still have major cough spells and it all comes out ... lots of green ... then yellow ... its weird looking but i think they are called (bronchial casts) after doing research...  thats exactly what they look like ... my chest continues to feel tight and i do get relief as more phlegm casts etc.. come out ... but even if i breath better my chest is still tight and i have hear the asthma rattling sounds when i breath.

Doing my Albuterol treatments helps but maybe for an hour .. It seems there is so much crap stuck inside me.

SO i went to the doc couple days ago AGAIN ... this time he took chest XRAY and he said it looked clear ... but then said I sounded terrible, and what he heard with the scope sounded terrible and that I had bronchitis and he wanted to prescribe another round of steroids this time the Mythlprednisolone 4mg DOSPAK and he also another round of antibiotics BUT he said he wanted to give me an Antibiotic that he normally gives his patients with PNEUMONIA ... I asked WELL IF I DONT HAVE PNEUMONIA then why you want me to take it ... he said he thinks its what i need and that its a hard core Antibiotic ... So i said ok

now when i get home i do research on this Antibiotic i never heard of and its called LEVOFLOXACIN (LEVAQUINN) .. holy shit I mean i read side affects all the time on drugs i take and i do know everything has a risk ... but i have never read such a long long long list of things that this drug causes ... Turns out my cousin took this and had a major side affects ... I mean there is even a FACEBOOK PAGE for survivors of uses that still suffer from the use of Levaquinn.

I remember you telling me that the better choice would have been azithromycin ... So i called the Doc back and said I do not feel comfortable taking the Levaquinn and that i want another ... So I asked him i want the ZPAK which i will start today ... its a 5 day dose

Now I asked him if he thought i need an inhaler so he said that it wouldnt hurt ... so he gave me 30 day sample of DULERA which ive never taken ... But Dulera says not to take if your not sure you have asmthma and only take if regular steroid inhalers dont work ... But the doc said take this since it only for 30 days

As I sit here typing im calm with my breathing but if i try to take a deep breath i start coughing ... and crap still keeps coming out .. man when will it stop :(

taking steroid pills and steroid inhaler
the Xray being clear yet im dealing with all this
the Antibiotic i refused to take and asking for the Z PAK
the Stringy Bronchial casts .. man they look gross
the Dulera


... thanks Marc

Hi Joe,

 First I want to apologize for the protracted delay. I've had a number of issues with my internet connections, and AT&T finally came out and replace ALL of the hardware (router, wireless hub, gateways, splitters and some wiring). Still some weird issue left (just got off the phone with then a hour ago), but..we'll see.

 Regarding bronchitis, 90% of the time it is viral...with clear mucus, and can last a couple of months. Preferred treatment is starting with an oral steroid, just as you have, and adding an inhalation bronchodilator (albuterol). If need be, and a more serious case, moving up to a product like Dulera, Advair or Symbicort both reduces the lung inflammation with less systemic steroid side effects, and adding a long-acting bronchodilator for a better quality of control.
 The X-ray being clear is good in that you don't have fluids filling the lungs, but there is limits to its diagnostic value, since it won't specifically let you know the actual nature of the infection.
 Without the culture specifically identifying the type of bacteria, I prefer the azithromycin, since in addition to its anti-infective effect, it also reduces the lung inflammation, and is now being used in some patients with chronic bronchitis to decrease flair-ups
 The casts are coming from deep in your lungs where the airways are narrower. Also, winter air is drier, leading to a thicker mucus.
  Whether Dulera, Advair or Symbicort, all are effective in "cooling" the lung inflammation down, and retaking control. Good move by the doc.

  Summary: don't hesitate to follow-up with the doc. Bronchitis can take many weeks (up to a couple of months or more)to resolve, and may recur. Recognizing this allows you to be more proactive in the future. I hope you don't smoke, since that increases your risk of repeated and more severe infections. Good hot showers and inhaling the heated mist helps break up the mucus, and makes it easier to cough out. If the humidity levels where you live are very low, use a humidifier in the bedroom to help keep the mucus flowing.

Hope this helps!




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Marc Rubin, RPh Asthma Educator


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.


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.

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.

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.

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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