Occasional deep coughing problem after chest infection

April 8, 2009 2:43 AM

Why am I occasionally getting coughing/breathing problems still when swimming after a 2 week course of antibiotics for a chest infection 2 months ago? ( I am very fit).

Ok, it's a bit complitcated. I'm a 46yo male. I've had mild asthma for about 15 years. (Rarely affects me, I avoid triggers and am very fit).

Usually the only problem is if I get an infection (flu) that might subsequently reach my chest. This happens maybe once every 2 years, as it did 6 weeks ago. I always immediately go to my GP, get an antibiotic and fine.

However after the last time, the first course of Antibiotics didn't clear the infection, so I did a 2nd course (6 days each). I don't ever recall taking 2 courses before. (I always take natural yoghurt after antibiotics to replenish intestinal flora and alleviate tiredness also).

Anyway, problems still arise. Here's how: I'm a long distance swimmer. I train between 1 & half to 2 hours a day, 6 days a week normally, with occasional longer swims (in the pool at this time of year).
A couple of times after this course for a few weeks, when doing some explosive sprints, I started to cough, getting a feeling of mucus/matter deep in my lungs. Intensive intervals didn't product the same coughing effect.
Last week I was doing a 10km, 3 and a half hour straight swim, constant speed, for distance training. I started to get a "tickle" in my throat at about 2 hours and was constantly coughing for the next hour and a half. I finished my swim but it was tough, all that coughing under water, affecting my oxygen levels. I was apparently very pale after the swim.
About 7 hours later, I had a very difficult coughing fit for about 10 minutes, feeling like I was trying to "clear" mucus from my chest. It left me with sore lungs for the next 2 days. (The training day after a long swim is easy and the day after that is my rest day).
Tomorrow I'm due a 12km 4 hour swim. I'm nervous the same thing will happen again although I've been fine all week.
I would go back to my GP but I've been unemployed for almost a year now and can't afford it at moment without a more concrete reason.
Any thoughts appreciated.

posted by lndl to health & fitness (24 comments total)

The bug wasn't eradicated. Simply. In spite of all good efforts made via the anti-biotics the bug won and has stayed and moved in, very comfortably into your chest cells and called it home. There's a limit on what antibiotcs can do and what it can't.

Your best bet at this time - is to start beefing up that immune system of yours. Make your body inhabitable for the lurker virus, eat healthy - eat garlic, ginger, drink teas, lemon - keep an acidic environment within. Rest. Think positively. Make it hell for the lurker. Sit in the sun, laugh a lot, be surrounded by loved ones who think you're the best thing since french toast and then some. Then rest some more. Take some colloidal silver to kill off the last remnants and celebrate with love and gratitude that you're creating a healthier and wiser self. OK?
posted by watercarrier at 3:12 AM on April 8

Oh and NO swimming. That chlorine will not help the clearing out of the bug - at all. Go to the beach and get the sun without effort. You need to REST. R E S T. REST.
posted by watercarrier at 3:14 AM on April 8

Recovering from a bout of pneumonia _can_ take months, even after antibiotics, at least to get entirely back to your baseline. As far as a concern for another infection, you can just monitor yourself for feeling sick (fevers, headaches, chills, etc.) and coughing up more mucous.

However, pneumonia certainly can cause a bit of an asthma flare, which sounds like what's going on here, with lungs that tire out and a cough triggered by exercising. That usually is a good reason to see your doctor -- I know it's hard to do given your situation of being unemployed, but asthma does need to be gotten under control before it worsens. Probably you'd just move up 1 step in treatment... so if you only use a rescue inhaler right now, you might move up to a short course of an inhaled steroid, or if you're only on an inhaled steroid plus rescue, you might add a 2nd control medication. Whatever the meds, I'd recommend seeing your physician. These sort of symptoms are concrete enough a reason to do it.
posted by davidnc at 3:22 AM on April 8

With all due respect, watercarrier's answer is not correct, based on the details you've provided.

It sounds to me like you had a viral infection. The antibiotics will have no effect. You can take them for months and any improvement in symptoms will be simply coincidental. Antibiotics do not cure viral infections.

You have asthma and as such you have a disease with two components: hyper-reactive airway smooth muscle and inflammation of the air passages. When you have an irritant (in this case, a viral respiratory infection and the resulting damage to the respiratory tract by the immune response) you can get an exacerbation of your symptoms, which can manifest as increased wheezing and coughing, and then because of the inflammation, increased secretion of mucus by the cells lining your air passages.

The increased secrection and increased sensitivity of your respiratory epithelium (cells lining the airways) will improve with time. As with most respiratory infections, the coughing is typically the last symptom to resolve and can sometimes take 2-4 weeks to completely improve.

My suggestion (as a doctor and as a former fitness instructor): take it easy on yourself, both physically and psychologically. That is, don't be too hard on yourself if you're not at peak performance, especially if this was truly influenza as opposed to the common cold. davidnc's mention of steroids is a good one. A bronchodilator (albuterol) plus inhaled steroids (e.g., fluticasone, budesonide) can be helpful for even mild asthmatics to help control symptoms during viral respiratory infections if used properly and regularly.
posted by scblackman at 3:43 AM on April 8 [2 favorites has favorites]

Schblackman, I'm a healer in training. What did I suggest to Indl that was contrary to healing a viral infection. Awaiting your response. Thanks for the professional courtesy.
posted by watercarrier at 3:54 AM on April 8

I would call the GP and describe the symptoms you're having. Sounds consistent with either: bug still there, or asthma triggered by bug. You may find that albuterol and possibly daily inhaled steroid (flovent) will help clear up the coughing and breathing problems.

I'd also consider whether the water is a factor. If you are aspirating water, it might cause these symptoms. And if something else is causing you to cough while you're in the water, you might be more prone to breathing in water and causing even more irritation.
posted by zippy at 4:11 AM on April 8

watercarrier, there is no such things as "healers". There are doctors. If you are not a doctor, please do not dispense useless advice. For one, the FDA ruled in 1999 that colloidal silver is not recognized as a safe or effective treatment in over-the-counter products for any condition. Touting it marks you right away as a quack. http://www.youtube.com/watch?v=ahihGKZC5Kk

Indl, contact your GP. Breathing issues are never a small matter, and certainly not one to consult internet wackos over, which may not have any qualifications whatsoever. I have had similar issues in the past few weeks and am waiting on a diagnosis. Since you have asthma I assume you have a rescue inhaler. You may be given a cortico-steroid to take regularly which may help. But really the GP should be the one making the call, not us.
posted by splice at 5:21 AM on April 8 [4 favorites has favorites]

I have asthma, and what you described sounds just like asthma - the fucking mucous way down there, the coughing and shortness of breath. Do you take anything to manage your asthma? The chest infection may have brought the asthma back, or increased the range of what triggers it.
posted by KokuRyu at 6:07 AM on April 8

Indl:

Sorry about the churn in this thread. If you have substantive questions, I would recommend that you seek the advice of your GP if you're concerned enough about your symptoms. You'll likely improve over time with little additional intervention provided that you've no other medical/pulmonary issues. However, your GP may be able to provide additional symptomatic relief via inhaled steroids (which have been shown over and over to have minimal immunosuppressive effects due to minimal systemic absoroption), and inhaled bronchodilators. The use of these may allow you to pursue your athletic ends with fewer symptoms, but ultimately, your body will need to heal itself. In addition, your GP should be aware of your symptoms to make sure that they do not represent a different disease process that needs further evaluation.

wattercarrier's advice and condescending tone belies a remarkable lack of understanding of the fundamental aspects of science and allopathic (modern/Western) medicine. His/her prior statement about being "in training" also indicates that his/her advice may not be sufficiently informed. Of course, that provides a goodly percentage of the fun on MetaFilter and AskMe.

Best of luck with your symptoms and swimming, Indl.
posted by scblackman at 6:23 AM on April 8 [1 favorite has favorites]

Oh, yeah, and a puffer or bronchodilator will certainly help controlling symptoms while exercising (as an aside, trying to control asthma with lemons and teas is interesting, but once, when I asked my GP about naturopathic solutions to asthma he said "I have some treebark and grass and mulch and shit like that in my backyard, perhaps you'd like to roll around in it and see how it helps you), but you need to take a regular inhaler like Symbicort to help manage the condition. Symbicort is a lot easier on your body (it has no side effects) than an inhaler/rescuer/bronchodilator. Perhaps taking something like Symbicort for a while will help your lungs get back to where they need to be, and you may be able to stop taking asthma medication.
posted by KokuRyu at 6:35 AM on April 8

[Some comments removed. Offering an opinion is one thing. Grandstanding and insisting that you are correct is another entirely, and doesn't belong in here.]
posted by cortex at 6:39 AM on April 8 [1 favorite has favorites]

I think someone already mentioned this, but it's worth asking again: you mention being a mild asthmatic, but you fail to mention if you are taking anything (daily or otherwise) to control it.

My .02:

What you describe sounds like what I (as an asthmatic who tries to keep fit so I'm not a total mouth-breather) go through when I exercise after having neglected taking one of the medications designed to control my asthma on a day-to-day basis.
posted by PsuDab93 at 6:41 AM on April 8

That's the way things go with lungs. The disease is gone, but the weakness remains. Someone I know asked the same question to her doctor.
posted by Brian B. at 7:15 AM on April 8

If your GP told you that you had flu and then prescribed antibiotics, your first step should be to change GPs. And take scblackman's advice.
posted by Neiltupper at 7:18 AM on April 8 [1 favorite has favorites]

Stay away from the G*d damn pool until next winter.

I just pulled this at random but there seems to be a lot of evidence for a link between chlorine and asthma. It's definitely going to irritate your airways and make your lungs more fragile.

I'm your age, with mild asthma and I had a similar bug last year. It took months and a course of special antibiotics to go finally away. I was feeling desperately worn down by the end of it.
posted by bonobothegreat at 7:28 AM on April 8 [1 favorite has favorites]

Sounds like asthma to me - not the infection.

I had VERY mild asthma my whole life, never medicated, then all the sudden this year I got the worst asthma of my life. I was in the ER for it and am now on a daily steroid inhaler as well as a bronchodialator for when I can't breathe. It's been a really upsetting and bizarre development.

I've been wondering if there's some trigger in my region (the SF Bay Area) because a number of my friends have found their asthma worsening this year. It's been a bad year for allergies too, which is a trigger for a lot of folks.

So yeah, I'd suggest doing some reading about asthma and then going back to your doc to see if they can confirm or deny. IF at all possible, try to go when you are actually having an episode where you are not breathing well so they can listen to your lungs.
posted by serazin at 7:39 AM on April 8

As far as non-Western/Allopathic treatments for asthma go, I don't have a ton of experience, but I did try acupuncture before I started the steroid inhaler and didn't find that it helped me after about 4 or 6 weeks. The acupuncturist suggested I try it for a few months but I ran out of money.

I DO find noticeable relief from cordyceps which is a Chinese herbal medicine. You'd need a Chinese herbalist or acupuncturist to evaluate you first though.
posted by serazin at 7:43 AM on April 8

First I'd to thanks everyone for their response, and offer a few clarifications & questions:

I guess I'm not trying to diagnose by internet. I just wanted to discuss prior to making a decision about visiting GP. (It's very difficult and embarassing to be an educated professional who has paid their own way all their life to be worrying about small financial matters like the cost of a GP visit.)(No I didn't work for a bank!)(I have never raised a health issue on the 'net before).

Sorry about the delay. Since I posted I was out training, a typical day, 2 hours including about 45 minutes high intensity interval, some sprints etc as usual with no problems. I'm a pretty experienced swimmer, I don't aspirate water. Even with the coughing last week. My age is 46, my resting pulse is currently 52 because this year is "easy" training. Last year, training for the English Channel, it was 42. So that's a rough indication of my cardio level if of any use.

I'm a rationalist/engineer. While I appreciate proffered help, I'd old and educated enough to disregard homeopathic/naturopathic type remedies. Gimme the science baby, so I appreciate particularly those science-based answers, particularly scblackman.

OK, I don't medicate daily. I would only use a "reliever" once I encounter problems. I haven't used daily steroid "preventer" inhaler in 12 years. I have no other problems. Indeed this one only occurs when I really push long & hard, outside my limits, which are pretty high.

My understanding of asthma. Whenever I have had a chest infection subsequent to a 'flu, it is accompanied by wheezing and... that damn green yellow mucus in the morning. I (mis?) understood that the mucus was indicative of an infection, probably bacterial . One course has cleared this up in the past. This time the 1st course obv. wasn't enough, although almost (200mg 3xdaily x 6, amoxycillin) the 2nd course knocked it back. (I had had a cold a few weeks previously after a hour swimming (wetsuited) in 37F sea.) My GP is not keen to prescribe antibiotics, any more than I am to take them. He has always indicated when he believed I had a viral infection, and would not then prescribe antibiotics. I both trust AND like my GP. we have sat and talked about the apparent slide in a new dark age of willingly embraced ignorance, in the light of actual hard won knowledge. he didn't tell me I had flu. I got flu/chill after a difficult winter (in Ireland) sea-training swim. After the wheezing symptoms began to develop I visited him.

I have no intention of stopping swimming, unless forced to do. My life sucks at present and it is how I manage to keep going. (Stress may be a contributory factor, god knows there's enough in my life). I eat well, cook all my own food, plenty of fruit & veg, though I do like my chocolate a bit much.
Like many swimmers I have developed a mild allergy to chlorine, that could cause sinus irritation, which it doesn't because is easily avoided by wearing a nose-clip (same problem does not occur in sea). I don't think it is germane to the issue.

Correlation indeed may not indicate causation,as the saying goes, but I do have plenty of years of that same correlation. I have due to maybe travel/work circumstances over the years, not been able to visit the GP when required. In all those circumstances the infection lasted much longer.

The advice on the "preventer" type inhaler is good, I hadn't thought of that. I am also interested that scblackman says (ceteribus paribus) it may improve by itself.
I'm still planning my 12km/ 4 hr swim for tomorrow (training plan now demands one long session a week) I am also going to talk to my GP tomorrow afterwards. Unlike last week I will use my reliever once before the training session.

Agains, thanks for all the replies.
ps. I'm Irish. I talk too much, and I'm one of the quiet ones. Sorry for the long post.

posted by lndl at 8:01 AM on April 8

Just have to say, wrt

Take some colloidal silver to kill off the last remnants

Bad, bad, BAD idea. Look at what happened to this guy. I can't flag watercarrier's answer enough. The advice there is downright dangerous.
posted by kellyblah at 8:33 AM on April 8 [2 favorites has favorites]

You're not necessarily wrong about having a bacterial infection. My asthma sometimes means that an initial viral infection (e.g. flu) screws up my lungs enough so they are susceptible to a subsequent bacterial infection. You can ask your GP for clarification if you're unsure.

Otherwise the usual advice for managing asthma applies-- take your medicine, use your rescue inhaler when needed (and pretreat before triggers you can't avoid, as I see you're planning to do for your long session tomorrow), stay hydrated, and if you aren't getting better (usually measured by decreasing need to use the rescue inhaler), go see your GP. I have a hard time telling how I'm doing sometimes and tend to underestimate my symptoms; if you have the same issue, one of those little breath-measuring tubes might be useful (although beware, your numbers might read high even if your lungs are not totally healthy, because you are so active).

Enjoy your swims!
posted by nat at 9:04 AM on April 8

Nth-ing going to the doctor and probably getting a prescription for a steroid inhaler. I have mild asthma (almost never use my rescue inhaler) but last year a move (and all the dust it kicked up) triggered a week-long allergy attack after which I had a really terrible asthmatic cough. The doctor prescribed a steroid inhaler that I used daily for a couple of months, and then I was back to normal. Right now it sounds like your baseline level of inflammation is much higher than it was before; the steroid inhaler, with daily use, will get it back down to where it was before the illness. (At least this is my layman's understanding of how the steroid inhaler works; someone with an actual medical degree might be able to explain it more accurately.)
posted by pluckemin at 9:10 AM on April 8

Nthing scblackman. I just got over pneumonia (clear x-ray six weeks ago), and my GP warned me it could be a couple months before I was back to 100%. I still get coughing fits, though it's nothing like what I had during the pneumonia.

I'd be worried about the oxygen deficit (turning pale). Definitely consider some sort of asthma medicine to get your lungs open. But do take it easy. Even six weeks on when I push myself I feel it.
posted by dw at 3:58 PM on April 8

Thanks all. Update. Talked to my GP before training yesterday. He suggested 2 puffs of Ventolin (2 x100mg) 1 hour before the swim and monitor, which I did. I decided to only do 11km instead of 12km, swam comfortably for 3 1/2 hours, getting a bit tight in the chest next/last 10 minutes. Came in a full 8 minutes quicker than the previous week over the 10km stretch, due to complete absence of coughing. Bit tight in chest for some hours after, will take a Steroid Inhaler dose for next week.
Thanks for the help, it clarified things for me.
posted by lndl at 2:05 AM on April 10

[Seriously, watercarrier, chill the fuck out.]
posted by cortex at 7:42 AM on April 10