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Asthma/cough after walking pneumonia


QUESTION: Had mild walking pneumonia in July according to Xray at Mass General. Showed it was gone in September with new xray, same place. Cough continued and got worse for a few weeks. Feel like a constant low grade fever, but none, and off and on cough for 3 weeks, pretty raspy, but not sure if efficient/expectoring (sp?) anything useful. My cough just started to get better two days ago, but had Dr. appt. today. Listened to lungs. Said, "asthma" some kind of brochitis, residual inflamation from penumonia deal.  Put me on pregnisone 20mg to help with inflamation for 14 days. Also getting me a slow acting inhaler (forget brand, as didn't have that strength at CVS when went to pick up), will get Monday, and a fast acting inhaler, Pro Air. I can breathe decent, compared to when I had asthma as a kid 10-20 years old, so don't feel I need the fast acting one. Question: Just looking for a second opinion as to whether I jumped the gun getting help after 3-4 weeks feeling miserable and coughing my head off as it just in the last two days started to feel my cough was residing a bit. Pregnisone? Really? I'm 6 2 151 lbs. Not happy about taking that based on side effects, etc. But looking forward to taking the advair-like powder inhaler on Monday as I do feel I need to reduce the inflamation in my lungs and get rid of whatever is causing this. Supposed to take 3 weeks and see how I'm doing. Do you agree with this regimen? Thank you. Axel

ANSWER: Hi Axel,

  Without knowing if they did spirometry to determine degree of impairment, I have to go on the probability that this is most likely bronchitis of viral origin (which makes up 90% of bronchitis cases). Typically, prednisone would be administered if testing revealed peak flow below 50%, and would be stopped when backup to 70%, so...14 days? hmmm. Also, prednisone dosing generally 1mg/kg up to 60mg/day, max for 14 days. 151 lbs = 68kg. I typically see 50 to 60mg daily for about 5 days. Your doc is going lower dose, which could explain the longer regimen, but the side effects stink, and I'd rather nail it and be done in fewer days. Especially with the addition of the controller therapy (Advair or equivalent). I fully agree with that approach of using the controller med with the quick-reliever (Pro-Air HFA). And you want the Pro-Air, should you be in a situation of a major trigger that could really nail you until your situation is fully resolved.
  So, bottom line, I'd just take a more aggressive, but shorter course of the prednisone, and keep all else the same. But that part is your doctors call, and he has all the objective data I don't have.

Hope this helps!



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

Lung function test
Lung function test  

Chest xrays
Chest xrays  

That helped a lot. I decided to ask my Dr. when I got my ears cleaned out on Monday if I could just try the Breo inhaler for a few weeks first to see if that cleared up my lung inflamation/feeling, and that I thought 14 days of Prednisone was excessive. He agreed that he didn't like it either and that sure, I could just try the Breo first and that it would be OK to do a regimen of 5 days at two 20mg pills/day for 3 and 1 pill for 2 days if doesn't subside.

1. I have my breathing test I wanted to share with you, attached. As well as my xray comparison. Does this help? I feel I need to see a pulminologist for an accurate "diagnosis." Oh, and they never did go over it with me to say, you scored a D+ and should see a specialist. They do that a lot. Blood test was "unremarkable".

2. Have you had any patients experience side effects to using Breo? I seem to have phlegm voice using it so far and a bit of a dry mouth, but other than than seems OK.

3. How much longer should I feel 80% until I see a specialist? Yes, my cough seems to be 99% gone, but I still feel like flush face, low grade fever (which I don't have), some very slight dizziness while cooking in the kitchen for e.g. I could probably go work out (free weights) like last Saturday and feel "fine" after, but I'm starting to get impatient. Clears throat, again...

Thank you so much,

Hi Axel,
  Its looking like viral bronchitis hit your after recovering from the pneumonia (which may have been of viral origin). Not uncommon for viral bronchitis to last 6 weeks, so be patient.

 Regarding the pulmonary function testing, was the test executed at least 3 times, followed by an albuterol treatment, then repeated 15 minutes later to see if there was significant improvement, or did they just do the test without the albuterol?

 With your early history of asthma, and this time of year, where ragweed pollens and mold are elevated, there may be a tie in with asthma flaring up. Breo makes a great start to getting the issue under control, and after you have recovered, you may wish to be evaluated by an allergist to assess if a mild degree of asthma is present.

 A few questions:
    1) How old is the residence you live in?
    2) Any pets at home?
    3) Do you smoke?
    4) Any identified allergies/triggers?
    5) What is your occupation? Certain occupations expose there employees to airborne irritants which can set you up for airway issues.




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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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