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Asthma/Dry cough for 4 months

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Question
Hi, I am hoping you can advise me as to the possible causes of a chronic cough I have had for over 4 months. First off I should say that I'm a caucasian male in the UK, 37 years of age, 181cm tall, and have never smoked. Back in September I noticed an occasional very light, dry cough that I had every day. After about 6 weeks of this I went to my doctor. He sounded me and said he heard nothing, not to worry and give it a month. About a week after this visit (late October/Early November) my breathing worsened a lot. I was never wheezing but in my right lung there was a real heaviness, even a coldness or wet feeling with every breath. I continued to cough a lot, but the cough has always been completely dry and unproductive of mucus. I also remember back then I kept my window open all day long hoping fresh air would help, as a result I was always in the cold, which may not have helped.

I visited the doctor again and he said it was ok and to give it another month. Next time in December I visited a different Doctor, she sent me for an x-ray (which she told me came back clear) and then gave me two week-long courses of antibiotics. Now in January the constant strange feeling in my right lung has lessened by about 50-70%. I'm unsure if this was due to the antibiotics or if its more just time combined with not leaving the window open anymore and living in warmer conditions.

I am now being tested for asthma, the asthma nurse said it would be pointless to give me a spirometry test if I had a lung infection, so instead I have to take a peak flow test and record it morning and night for 2 weeks. For my height I should be getting 640 but it has always measured around the 550 mark, and using the inhaler (salbutamol sulphate 100micrograms) doesn't affect this result.

So where I am now: there is a constant, very slight feeling of discomfort in my right lung which feels worse in the cold. Whenever I get up and move around I begin to cough, a loudish dry cough. This will last constantly when I'm moving (e.g over an 8 hour shift at work). There has never been any blood or mucus. My left lung feels perfectly fine and always has. The location of the discomfort in my right lung seems to vary - sometimes more central, sometimes upper right of lung. As for breathlessness, I am very unsure - there are times I feel a little out of breath, for instance when I am wrestling with my nephews or have briskly walked for 20 minutes to the top of a hill. But then I question if I was always a bit puffed out after doing those things and am now just paranoid or depressed. I can still certainly do a full 8 hour shift of stacking shelves, on my feet and carrying things all the time, without breaking a sweat or having to stop for breath.

Do you have any ideas what could cause this?

Answer
Hi Barry,
  First, what is your present weight?
  Any family history of lung problems?
  Did the doctors do any blood testing, like a complete blood count with differential (CBC + Diff)?  Elevated eosinophils and/or neutrophils help give some diagnostic direction. If yes, did they give you any of the results?
  Do you find any differences in your lung sensations varying with the time of day, say, for instance, worse overnight and early morning, but improved mid-afternoon?
  
  You say your job is stacking shelves. What kind of environment is that in? A retail store, factory? Are chemical agents present that may be giving off fumes?

  Don't get hung up on the peak flow numbers the nurse gave you for normal. Those are approximate values. Just like a bell-shaped grading curve in school, most people fall in the middle of the curve (and have a C grade average), but there are those whose numbers may be normally higher or lower. When used properly as an asthma evaluation tool, the patient tests themselves daily for 2 weeks, and the highest value attained is their own "personal best" from which you base impaired breathing issues.

  An aspect that concerns me is that, if you have been taught the proper technique with the salbutamol inhaler, and there is no improvement, it is either that there is no lung impairment...which is great, or, the impairment is not reversible, such as in an obstructive lung disorder or a condition called sarcoidosis. Personally, without any spirometry testing done, at this point, there is only conjecture.

 I'll watch for your replies to above questions.

Thanks!

Marc

Asthma

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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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