Coughy, a/k/a the 8th Dwarf

November 13, 2007 6:32 PM

Coughy Asthma versus Wheezy Asthma?

I was diagnosed with adult onset asthma three years ago (five days after delivering my second child). Since then, every winter I get slammed with asthmatic bronchitis. This year it's come nice and early.

In the past three weeks, I've been on three rounds of Medrol (two of them mega doses starting at 20mg and lasting 12days), along with two rounds of antibiotics (Clindamycin and Bactrim). I also take Singulair, Asmanex and Xopenex HFA.

I finally got rid of two weeks worth of an incredibly disgusting sinus infection, along with upper respiratory ick. The goo is gone, but not the cough. I've never been one of those 'wheezy' asthma people. It's the coughing kind. So, when is it time to hit the magic rescue puffer?

I spoke to the Pulmonologist yesterday and he upped the Asmanex to three inhalations twice daily. The other alternative was to go back on the Medrol. I am SOOOOO not keen on staying on all these steroids for so long. By the way, I did ask him about the rescue puffer and he was kind of vague about it, since he still references the wheeze, not the cough.

posted by dancinglamb to health & fitness (12 comments total)

Beware the rescue puffer!

(note: I am not a doctor) In my experience, if you use rescue meds like albuterol too much, they will not work when things really go south. Take it from someone that got pulled off a train for not breathing after a bad attack. And then stubbornly refused steroids.

I am not slightly less of an idiot and now a compliant patient. Or at least as compliant as I am about anything.

Consider nasal lavage like the whole neti pot/sinus rinse thing. It does wonders. Take the Asmanex or the steroids (Asmanex will probably be less hard on you and probably make you less hungry and crabby and bloaty). Take prescription cough medicines if they're prescribed for you.

Do not think about the "ooo steroids" thing. If you do not calm the inflammation, that cough will become bigger and badder. And the damage can be extreme.
posted by answergrape at 6:50 PM on November 13, 2007

dancinglamb--some asthma suffers are coughers, not wheezers. (I am more of a cougher, wheezing comes when I am *really* going downhill!).

You may want to ask about using a saline nasal irrigator (see Grossan or similar). Maybe you should ask about an ENT referral?? My ENT claims most sinus infections can be taken care of with saline irrigation.

YMMV. I am NOT your medical provider, yadda yadda. Good luck!
posted by 6:1 at 7:05 PM on November 13, 2007

When is it time to use the rescue inhaler? (This seems to be your question)

I'm a lifelong asthmatic. I 'feel' tightness in my chest, and know then to use the rescue inhaler. Quantitatively, when I feel the tightness, my PEAK FLOWS are about 50% of normal.

Wheezy or coughy, (I get both) I would measure a peak flow and if it's significantly off, use the inhaler.

Out of curiousity: If you're on Asmanex and Singulair, why don't you just use Advair (which is Singulair + corticosteroid)? I've used Advair twice a day for several years now and my rescue inhalers now always expire before I'm able to use them more than once or twice.
posted by u2604ab at 8:30 PM on November 13, 2007

I'm not a doctor, but I've had asthma for all of my 40 years.

Coughing is when you have stuff in your lungs that you are trying to get out. Typically it's too much mucus or the leftovers of an infection.

Wheezing is when the bronchial tubes are inflamed so much that air whistles as it goes in and out.

You can have both issues at the same time.

A 'rescue inhaler' is a bronchodialator (usually abuterol). It is a special stimulant that forces your airways open. If you are only having a wheeze, the wheeze stops because the airways are now wide open. I use my inhaler when I start to wheeze (usually after yard work even though I wear a respirator). I NEVER let a wheeze go on for a long time without treating it. If an inhaler isn't available, a large dose of caffeine will work.

So if you have stuff in your lungs and you use a bronchodialator, your airways will open, but you will still cough to get the stuff out.

In your case, my guess is you still have some crap in your lungs. While rinsing your nose is a good idea, it won't help your cough at all.

Medrol is the hard hitter of the medicines you are on, and you are on a lot of them. Medrol is a strong anti-inflammatory, so they really want to try to reduce the inflammation. Singulair is a preventative, Asmanex is an anti-inflammatory, and Xopenex is a bronchodilator.

You are on pretty full slate of stuff.

Perhaps you want to discuss using a nebulizer with abuterol to help open your airways. The nebulizer is a breathing machine that pumps air into medicine so you can inhale it. It takes about 10 minutes of breathing through a little mouthpiece.

I keep one in the closet for when I am having a tough time. It's very effective in stopping an attack and getting your airways OPEN.

Sorry for the long answer, but hopefully it helps.
posted by Argyle at 9:24 PM on November 13, 2007

u2604ab: I take the Singulair all the time as a preventative. The Asmanex only comes into play when I've been sick or it's asthma 'season' (humidity tends to set me off). The Xopenex is the rescue puffer.

The only thing that I can think of as to why I haven't been prescribed Advair is that is may be contraindicated due to a tachycardia problem I have. (I can do prednisolone but not prednisone, and I can do levalbuterol but not albuterol, etc.)

I did the peak meter a couple weeks ago when I had to make an emergency trip to the doc in the box and I was at 30% of capacity. I'm thinking I'm going to have to schlep into the Pulm's office tomorrow.

answergrape: thanks for the headsup on the rescue puffer warning. I dug out the prescription codeine cough med tonight. That shit is beyond nasty, but I just can't take the coughing any more. I threw in some Sudafed to see if it might be post nasal drip adding insult to injury. At least I've now made it a half hour without waking up the dogs from hacking up a lung or two.
posted by dancinglamb at 9:34 PM on November 13, 2007

Call your doctor.
posted by 6:1 at 9:36 PM on November 13, 2007

Hey Argyle- Thank you. I asked the Pulm about the nebulizer and he told me that he felt they were only useful for people that didn't know how to use inhalers properly. He said that the inhalers deliver a more accurate and quicker dose of meds to where they need to be. Dunno.

Last winter he had me on Medrol for well over a month. The other alternative was being admitted. That's not realistic with two little kids at home.

When I had the sinus/upper respiratory thing going on, there was just pure nastiness coming out of my lungs. I don't feel/hear it rattling around any more, though I guess that doesn't mean it can't be down deep.

What drives me crazy is that I had NONE of this until I developed pneumonia five days after delivering my second kiddo. Was dx with the pneumonia and asthma and it's just been prevalent every single winter since. My brother has had asthma/severe allergies his entire life, so they told me that I probably had it but it was latent. Makes no sense to me. I'm just hoping my kids don't end up with it.
posted by dancinglamb at 9:42 PM on November 13, 2007

I was told the complete opposite from answergrape by my asthma nurse. She says to use the rescue inhaler whenever I have the slightest hint of a breathing issue, because being inflamed over a period of time can cause long term lung damage. I'm also a cougher rather than a wheezer.
posted by happyturtle at 11:54 PM on November 13, 2007

I get a little bit of both coughing and wheezing. I've had the most success with Advair, which is a preventative. I was on a pretty huge dose of it, and I don't think it has impaired my ability to breathe normally when I am not having a fit. (I only use it routinely when I know I'll have problems - high ozone periods during the summer, winter weather, flu season, etc..)

But I'm not a doctor, so I don't really know what to suggest. Sounds like you are trying a few things already.
posted by greekphilosophy at 5:52 AM on November 14, 2007

It may be time for a med change. I've had asthma and allergies my whole life and I've been on several different meds depending on season and effectiveness. I've found that some are really good and never seem to stop being good (Advair in particular) and some just didn't work for me at all.

I'm just getting over my first sinus infection in two years, a miracle, really, considering I used to get them at least three times a year. If I hadn't had the Advair, I would most certainly have been in the hospital at some point.
posted by cooker girl at 6:13 AM on November 14, 2007

Your resp. system is all connected. If you are getting frequent sinus infections, the drainage may be going to your lungs and that *may* be why you are having problems.

I know for me, this is why I have to stay on top of my sinus infections. That's why I said and ENT referral may be in order, possibly with an Allergist to try and treat the sinus end and maybe it will help with the lungs.
posted by 6:1 at 7:19 AM on November 14, 2007

Look up Reactive Airway Disease. In my case, and maybe yours, triggered by cold, dry air. The 1st cold I get in fall/winter generally leaves me coughing til the 1st warm spell of spring. Dry, non-productive cough, and tightness in the chest. Cough drops with Mentholyptus are really effective for me, and when it settles in, I use a steroid inhaler daily. I seldom, if ever, need the rescue inhaler, which is good because I had other troubles caused by it.
posted by theora55 at 9:49 AM on November 14, 2007