Who to believe- my doc or my pharmacist or random people in my life?

March 13, 2013 9:40 AM

Should I keep pouring different meds into my poor body to fight this beast of a chest cold?

YANMD and YANMPharmacist. That being said, I need advice. I have been crazy sick for the past 2.5 weeks. It started off as just a sniffly cold. Then in the 2nd week, it escalated into a really bad cough and congestion. I went to my doctor and he gave me three prescriptions - for Robutussin with Codeine, for Advair (an inhaler) and for Prednisone. He said to try the first two for a few days and then if I wasn’t feeling better, to go to the Prednisone.

I went to the pharmacist and tried to fill the first two. The pharmacist was shocked that my doctor had prescribed the inhaler, given the fact that I don’t have asthma or allergies, and was extremely reluctant to fill it. We only filled the Robitussin. I took the robotussin for 4 days. It did nothing and I got worse. Finally that Saturday (2 week mark from getting sick), I filled the prednisone prescription. It’s a 10 day cycle and today is day 5. I've been really bad the past 4 days but today I have for the first time started to feel slightly better.

This is where things got stupid. I mentioned to some friends last night that I'm on prednisone and they freaked out saying it lowers my immune system and I'm just putting myself at risk for something worse and I should be on antibiotics, etc.

I called my doctor this morning and he said that I was supposed to be taking the Advair and prednisone together and should get the advair right away and start taking it too. I am terrified to put yet another drug into my body. The congestion DOES seem to be breaking up a bit as of this morning, but I'm still sneezing and coughing my brains out.

My question is: Do I A. stop taking all meds, since I feel like my poor body is going to explode from all this crap. B. Keep on with the prednisone and hope that things will clear up, even though everyone tells me that it’s a steroid and super bad for me. C. go to pharmacist and try to get him to fill the Advair and go on that too even though he was 100% against it. or D. Go back to my doctor tonight and have him re-evaluate me.

I know the go-to advice is to see a doctor, but.. my doctor seems to be in conflict with everyone else I talk to.

posted by silverstatue to health & fitness (26 answers total)

Prednisone is a sucky steriod, but by-God, when it works, it's a fucking miracle.

I sure hope my cousin, Treehorn-Bunny pipes in, because she's awesome at this stuff. But she has a newborn, so her hands are full.

My inclination would be to follow my doctor's instructions. If my pharmacist has a concern, I'd probe more to understand.

Here is a blurb, it's for the professional, about a possible drug interaction between advair and prednisone. It talks about lowering of potassium levels as a posible interaction effect. (Hypokalemia) you might want to ask your doc if you should supplement, or eat more naners or something.

Again, your friends are well meaning but being alarmist. Your doctor is your doctor and you should have faith. Your pharmacist is being cautious and I'd appreciate that.
posted by Ruthless Bunny at 9:48 AM on March 13 [3 favorites]

A couple questions. Is your cough productive? I.e. are you coughing up stuff?

Do you have asthma? The prednisone and the inhaler are what your doctor would give you if he suspected an asthma-ish inflammatory airway process.
posted by killdevil at 9:49 AM on March 13 [1 favorite]

I am not a doctor, obviously not your doctor, and obviously am not looking at your sputum in a petri dish, but I would like to share with you my experience:

When I was in college, my boyfriend and I both got sick with a cold. It was a nasty cold, we had the same exact symptoms, and we were the only ones in our dorm who had it. We were both sneezing and coughing, and both had this awful, phlegmy, hacking cough. (I say this just to suggest the likelihood that we had the same bug.)

When it hit a week of sickness, we both went to the student care center to get en-drugged. We saw different doctors at the same time--I came out with a script for a Z-Pak and he came out with a script for an Adavair inhaler.

I got better immediately, like within a day. His cold (cough included) lingered for another 2.5-3 weeks all while using the inhaler as issued by the doctor.

I say this all to suggest that you go and get a second opinion, pronto. Colds shouldn't last this long. Sorry you're feeling so crummy.

Also, personally, I would have to be at death's door before agreeing to take prednisone. My dad was on it for years and that shit is awful.
posted by phunniemee at 9:50 AM on March 13

if you don't trust your doctor, get a new doctor. that one is actually pretty straightforward. there's no point in seeing your doctor against considering you didn't follow his instructions the first time - it's a waste of time. find somebody you trust and do what they say -
posted by facetious at 9:50 AM on March 13 [8 favorites]

If you are suspicious of what your doctor says, you ask another doctor, and not your friends. If your pharmacist raises some questions, you ask your doctor (who has examined you), and/or find another doctor. I would distrust a pharmacist who tells me to disregard my doctor's prescriptions, barring a possible drug interaction.

No one here can tell you which treatment plan to go with, but please please go see another doctor.
posted by specialagentwebb at 9:58 AM on March 13 [7 favorites]

I have asthma and get prednisone all the time when I have respiratory illnesses. Steroids do lower your immune system long term (that's why they are used for auto immune illnesses....to calm down your immune system) but a short 10 day course doesn't put you at a huge risk for catching anything. Keep taking the prednisone...it takes down the inflammation in your lungs and makes breathing easier.

Many upper respiratory infections are viral, so antibiotics won't work anyway. It also takes time to get all the gunk out of your lungs so be prepared to cough for a couple of weeks longer even after everything else clears up.

I haven't heard of Advair being prescribed for someone without asthma or COPD, but I have heard of an inhaled corticosteroid prescribed (like Flovent) when they are having serious trouble breathing or wheezing. An albuterol inhaler can also be prescribed for an infection. So the Advair script makes me wonder if he meant to prescribe something else and thought of the wrong thing. An inhaler isn't required to treat this though so if you are feeling better with the prednisone I'd say the Advair isn't necessary. IANYD though...just someone who's ridden this merry go round.

In short, if you are feeling better, keep doing what you are doing. If you are struggling to breathe talk to the doctor again and share your concerns about the Advair. The doc may have additional information or experience with Advair that we don't. It's OK to ask questions!
posted by MultiFaceted at 9:59 AM on March 13 [2 favorites]

Anecdotale "evidence": Mrs Procrastination had exactly the same experience as phunniemee- weeks on an inhaler didn't clear up the cough, but a Zpack did in one day. It was probably pertussis.
posted by procrastination at 9:59 AM on March 13

Mother of God, that sounds like a lot of drugs. Prednisone, codeine and an inhaler for upper respiratory problems? REALLY?

I had a cough so bad last year that I had bruised ribs - it was probably bronchitis but I never got a conclusive diagnosis. I got prescribed a Z-pack and took ibuprofen for the rib pain. That was it. It went away, but it took a while.

I would get a second opinion and if you like that doctor, stick with them. If you are having trouble breathing at any point or your fever spikes in the meantime, hie thee to an ER.
posted by Currer Belfry at 9:59 AM on March 13

I tend to trust my doctor.

I've taken Prednisone twice in the past because of a bad wintertime virus, and it works well.
posted by KokuRyu at 10:00 AM on March 13 [1 favorite]

2 weeks is an awfully long duration for a viral upper respiratory infection. You may have developed a sinusitis in the aftermath of your cold, which continues to give you URI symptoms (runny nose, etc). Even if the sinusitis is bacterial, antibiotics do not reduce the duration or severity of symptoms according to recent studies. The prednisone and inhaler were probably meant to address inflammatory airway symptoms which can develop even in people who don't have "asthma" per se. Your doctor probably heard you wheezing with his stethoscope; inflamed airways are pretty easy to hear that way. So they're not necessarily bad meds for him to have prescribed.

If your cough is productive, particularly of discolored mucus, you should have a chest x-ray to rule out pneumonia. That might not be a bad idea in any case given the length of symptoms.

Source: I'll have an M.D. in a couple of months.
posted by killdevil at 10:01 AM on March 13 [5 favorites]

I'm a nurse, but not your nurse, so I will comment on the treatment your doctor prescribed only in general.

It is not at all unusual to prescribe medication for symptoms such as congestion, wheezing, or cough with a medication that was developed for a similar condition that might have similar symptoms, in this case asthma. I'm referring to the Advair. This was prescribed to help reduce your symptoms.

The Robitussin with codeine is a cough suppressent (from the codeine) and is intended to reduce the cough so you can sleep, or to reduce the cough so you don't hack continuously and develop muscle pain from the force of coughing. This too, is targetted at general symptoms, and is probably mostly aimed at your comfort. My kids were prescribed it when they had pertussis. It's very commonly prescribed for cough.

The prednisone, which I guess is a taper (larger dose, followed on successive days by smaller doses) is to immediately reduce inflammation. Prednisone tapers are widely prescribed for all sorts of severe inflammation, from bad cases of poison Ivy to rashes from all sorts of things, to acute disease flares. When used for a short period of time, like 10 days, they will not comporomise your immune system. That is much more of a problem with long-term use, such as chronic conditions.

An antibiotic would only be prescribed if the doctor suspected a bacterial cause. In fact, it is irresponsible for him or her to prescribe antibiotics on the off-chance that your illness is bacterial rather than viral. Most upper respiratory infections are viral, but sometimes prolonged congestion can cause a bacterial infection, as well. There is lots of evidence that antibiotics are inappropriately prescribed, and are adding to antibiotic resistance.
posted by citygirl at 10:04 AM on March 13 [18 favorites]

Did you have a pulseox done at the Drs office? (little thingie clipped onto your finger). Do you have trouble breathing?

If the doctor saw your blood oxygen levels dip/heard wheezing, and you don't have asthma, Advair would be a logical prescription for you, despite what your pharmacist said. And your Dr. would be right to be freaked out that you aren't taking it. Advair would help keep inflammation and mucus in your lungs down, improving lung function.

So, IANYD, but I can say that if I, (a person with asthma), went to my doctor with a chest cold that had been sticking around I might get a prescription for a (increase) of Advair and prednisone. And prednisone can be awesome and finally get you over a lingering cold. Yes, it is a steroid, but it can do wonders. I, personally, would also be at a big risk of developing pneumonia and my Dr. would want to see me again unless I was hugely improved in a week.

But regardless of all of this, go to another doctor if you'd like. Also, seriously, the pharmacist should call your DOCTOR not grill YOU on what drugs you're being told to take.
posted by fontophilic at 10:06 AM on March 13 [2 favorites]

Don't let anyone offer you a Zpack!

It sounds like your doctor did not make anything clear to you. Find a doctor who will explain things better.
posted by mareli at 10:11 AM on March 13

I'm not a doctor or pharmacist and I don't know anything about either the drugs or the symptoms you're talking about. And I don't know who you should believe. But I do know what I'd do:

First, when the doctor prescribed something, I'd trust him, and go to a pharmacist to get them filled.

Second, when the pharmacist said this is weird, I'd trust them at least enough to call up the doctor and address the pharmacist's concerns to him.

Finally, I would seriously consider getting a second doctor's opinion.
posted by Flunkie at 10:14 AM on March 13

Interestingly, I was listening to the radio yesterday where it was discussed that antibiotics are not particularly useful for sinus infections.
posted by KokuRyu at 10:20 AM on March 13 [1 favorite]

Hi everyone. Thanks for your input thus far. I havent had any fever throughout this and not really had trouble breathing...just stuffy/drippy nose. My doctor did not do a chest xray- just listened to my lungs. In his defence, its probably my fault I messed up on the prescriptions. I was pretty out of it when I saw him. Ive gone to him for 8 years and he's always been trustworthy.
posted by silverstatue at 10:21 AM on March 13 [1 favorite]

It's possible to develop allergies and your symptoms sound like ones that I've had with allergies. I didn't have allergies until I was in my thirties, and my reactions to allergens vary from year to year and place to place. where I live now there is endless pollen and I've been feeling it.
posted by mareli at 10:25 AM on March 13

Typing one handed with newborn in other hand. I am not your doctor, this is not medical advice.

- I routinely prescribe inhalers for people who do not have asthma if they are wheezing on my exam. Your pharmacist may be inexperienced if they are not familiar with this practice.
- Prednisone is not a bad drug, it is a wonderful, lifesaving drug that has potential side effects and should only be used when the benefit outweighs the risk. Respiratory infections are one of the most common reasons for steroid prescriptions.
- A chest x-ray is not necessary to diagnose respiratory infections in most uncomplicated cases.
- Antibiotics are not necessary, and in fact are not recommended for acute uncomplicated bronchitis or any other likely viral upper respiratory infection.
- Cough syrup, an inhaler, and a pill is not "a lot of meds" and will not "make your body explode". Consider yourself lucky as many people have to take more medication than this every day of their lives. I see patients with med lists 2 or 3 *pages* long.
- It is not unusual for a cough from a respiratory illness to last 2 weeks

In short, nothing you have written convinces me that your doctor has done anything wrong, if you want to get a second opinion on nasal congestion/runny nose, then go ahead but it might seem a little over the top. Keep in mind that postnasal drip can be a source of persistent cough.
posted by treehorn+bunny at 10:45 AM on March 13 [27 favorites]

Doctors make mistakes all the time. You should go to a different doctor and see what they say.

Why didn't the pharmacist call your prescribing doctor? Have you left a message with the doc?
posted by discopolo at 10:56 AM on March 13

I can't speak to your symptoms, but my pharmacist -- who I trust -- always calls my doctor -- who I also trust a great deal, but is not an expert on all drugs -- when I am prescribed something that he has concerns about. This happens once in a while. I prefer that course of action myself. They talk and then get the meds I need.
posted by Lescha at 10:58 AM on March 13

I haven't heard of Advair being prescribed for someone without asthma or COPD, but I have heard of an inhaled corticosteroid prescribed (like Flovent) when they are having serious trouble breathing or wheezing. An albuterol inhaler can also be prescribed for an infection

Advair IS an "inhaled corticosteroid"--in fact, it contains the same active ingredient (in addition to some other stuff) as Flovent. Albuterol is simply a bronchodilator--it would not be prescribed to fight an infection.

In other words: don't listen to your friends or to random people on the Internet (including me). Listen to the person who is a trained professional who has actually examined you: i.e., your doctor. Your pharmacist is dangerously irresponsible and I would strongly advise you to find a pharmacist who does not seek to interpose him/herself between the patient and the doctor on such an uninformed basis (if this had been a case of catching a known drug interaction or something then that would be another matter; in this case it's just ignorant, dangerous and absurdly inappropriate meddling).
posted by yoink at 11:02 AM on March 13 [4 favorites]

Oh and really are people still so unbelievably uninformed about antibiotics as this? The idea that your friends would be FREAKED OUT by you taking prednisone while advocating popping antibiotics as if they were candy is just so ridiculous it makes my head hurt. Antibiotics are very serious medication. They can have very long term side-effects which we are only just beginning to understand. They should only be taken when it is clearly necessary and when the benefits clearly outweigh the risks. They are almost always the wrong thing to suggest for someone who has a lingering cold. I would take a prescription for prednisone (which, of course, has its own risks) any day of the week rather than antibiotics.
posted by yoink at 11:08 AM on March 13 [9 favorites]

Yeah, your pharmacist should not have contravened your doctor without a discussion between them and with no immediate error or interaction to worry about. That's some bullshit right there.

There is a nasty upper respiratory thing going around widely that presents as you describe and lasts for a week to a month as a lingering cough. It's been all around in NYC. The fact is it will most likely get better by itself (and then you'll credit whatever you took last).

Obviously, the oral and inhaled steroids are for symptom management, not curing you (hence to compare to antibiotics is foolish). You may well have a secondary bacterial infection in your chest. And it may respond to antibiotics. But for immediate symptom relief your options are decongestants, steroids, hot tea, lozenges, or opiate cough suppressant if you have a really bad non-productive cough. (Non-opiate suppressants, we now know, DO NOT WORK). Mix and match. None of them are dangerous (except the opiate) taken as directed for a brief period for symptom relief. A short course of prednisone won't destroy your immune system, sheesh.

There is nothing that dangerous about a few days of prednisone plus an inhaled steroid, and you are freaking out for nothing. They will make it easier to breathe. If you don't like drugs, don't take them in this case and you'll get better anyway, just less comfortably... Try tea, steamy showers, and Halls cough drops if you haven't.

The cough takes a long time to go away, but it gets better steadily. Really, I know a dozen people who have had or have this, including me. You cough so much your chest hurts. Just be patient.

I would mostly be concerned here about your reckless pharmacist and your over-anxious friends.

(IANAD.)
posted by spitbull at 11:15 AM on March 13 [3 favorites]

Back in college I had a persistant repiratory infection that took 3 courses of antibiotics and a lot of rest to finally get over. My lungs havent been the same since. A couple years later another bout of respiratory infection left me with a persistant cough and asthma. I didma course of prednisone to get the cough under control and used asthma meds regularly for 5 years or more before things kind of got back to normal. And then, a month ago, a nasty virus brought it back, at least temporarily, Zpac has helped get things moving in right direction, but my lungs are still screwed up.

My point here: your friends don't know what they are talking about, and honestly, your pharmacist may have been right to raise a red flag, but you and he should have resolved it by calling your dr on the spot. The inflamatory response from some respiratory infections can mess you up long term. Your doctor may not have the exact right solution, but he seems to be trying to keep things from escalating.

Really, you need a doc you can trust. That doesn't mean they cant be questioned, but honestly wtf is up with letting a pharmacist and your random friends derail your doctor's suggested course of treatment?
posted by Good Brain at 3:07 PM on March 13

First of all, thanks everyone for all your calm, detailed explanations. I really appreciate it. I was freaking out this morning! I'm usually the healthiest person ever, so this whole thing has made me super nervous. If I had been in a right frame of mind when I saw the pharmacist last week, I would've had him call my doctor to confirm the right course of action. As it was, I could barely stand up and just wanted to be home in my bed as quickly as possible so I just took what he said at face value. In the future though... I'm going to a different pharmacist!

My doctor has always been great and I shouldn't have doubted him. I went back tonight and he gave me the Adavair and I'm already feeling way better. He said it should clear up everything in about 48 hours. I am crossing my fingers!

So, lesson learned. In the future, listen to my doctor!
posted by silverstatue at 4:57 PM on March 13 [4 favorites]

You need a new pharmacist.
posted by karlos at 7:21 PM on March 13 [2 favorites]