[milestogo/homenurse]

home health nurse here, wanting to pick your brains....
i have spent the past 4 months with a chronic cough. after what seemed like an md appointment or a procedure every other week, it has been determined by my pulmonologist and internist that i have cough variant asthma- i had never even heard of this before now. I'm 41, never smoked, but admittedly about 40 # overweight. and beginning to feel very, very old. i have had my meds adjusted 3 times and still need a rescue inhaler 3-4 times a day. much of my weight gain has come from being on steroids x 3 and getting SOB walking around the block.

i am currently taking :
advair 500 bid
singular 10 at hs
mucinex bid
claritin 10 daily
zantac 150 bid
using a portable jet neb (albuterol) that i can plug into cigarette lighter during the day, but usually just using this at hs to help me sleep and relying on the albuter inhaler.

i cover a rural/peach farmer/cotton fields/migrant workers heating with wood burning stove type territory. i know certain patient's always trigger an attack and i just use the albuterol before entering the home, but am getting so frustrated. patient's look at my as if i have some dreaded disease. i always explain my situation to new pt/families to relieve their concerns, but am wearing out. many nights i only get 3-4 hours sleep before waking to take another nebulizer treatment to get through the rest of the night. often have to sleep in a recliner.

shouldn't i have better control than this, or am i just having wishful thinking that i can continue to be in a job that i can't control coming into contact with known triggers- pollen/cigarette smoke/perfumes etc.
my internist says its just a matter of finding the right combination of meds. i feel better for a week or two, then start on a downward decline again. this has been a hard week. south carolina is one big pollenating cloud of blooms right now....

any advise??, would appreciate it. thanks

[NRSKarenRN]

I've been walking in your shoes this month.
This winter has been trying with a WICKED Respiratory virus and bacteria going around taking 3 weeks to clear in many patients with asthma.
In addition to the above symptoms, do you snore?? If so, a sleep study to rule out Sleep Apnea would be indicated.

Some people do better with Flovent + Servent inhaler instead of Advair.
Time released Theophylline helps some people.

What's your peak flow meter reading? Need to monitor it regularly pre and post meeds to see if meds working. Are you using a space chamber with inhalers--that helps too.

Cough Variant Asthma links:
http://asthma.about.com/b/a/154185.htm

Medscape--free registration, great website: Cough-Variant Asthma

Comparison of atopic cough with cough variant asthma: is atopic ...

http://xnet.kp.org/permanentejournal/sum04/cough.html


Hope one of these links is helpful.

[milestogo/homenurse]

had the sleep study already. occasional apnea episodes, but not significant enough to treat per the pulmonary doc.
hadn't thought about the space chambers. will try, can't hurt.
no one has had me measuring peak flow readings. i'll ask about this.
so far, everything is based upon my response to the meds/basically, how long i can go without coughing/or how well i sleep through the night. i think both docs think that this will pass with the coming of summer....hopefully!!

[oramar]

No one has actually used the term "cough varient" with me but this sounds like me. I rarely wheeze, my symptoms have always been primarily coughing. My medications are very similar to yours but my pulmonary MD believes in Prilosec. He strongly believes that reflux plays a role in the coughing. Thought I would mention that to you. I notice that you take Zantac but I think that Prilosec or it's expensive cousin Nexium are much more effective.

[milestogo/homenurse]

thanks for the post. i went through a swallow study and a ph probe and the gastroenterologist says i'm normal. LES is intact.
i was on nexium, but insurance won't pay for it with all of the otc options available. with the above tests coming back norm, just decided to go back to the cheapest option. i rarely have reflux symptoms and then only when i eat something that i know i should have avoided in the first place.
today was one of the worse days i've had in a long time and all i'd had to eat was some saltines that i grabbed to take in the car with me.

just trying to take it one day at a time/ praying for a heavy rain to help wash away some of the pollen.

[RRT/RN]

You could try using Atrovent along with you albuterol inhaler/nebulizer. Using both seems to help a lot of people. You could also try 0.5mg Pulmicort via nebulizer (its an inhaled steroid). Have you had a pulmonary function test done? That would tell you pretty definitively if the bronchodilators are helping you.

[Judee Smudee]

Just posting to say that I hope Milestogo is feeling better. And that goes for the other posters that said they were suffering. Let us know.

[milestogo/homenurse]

Thanks for the concern. i am feeling better actually. had allergy testing done and am highly allergic to bahair grass....which of course is everywhere here in southcarolina. the good news was that i'm not allergic to my 3 dogs or to dust/molds etc.

my doc added in nasonex. this seems to have been a magic bullet for me. i'm still on the singulair and advair along with the nasonex. i'm only needing my albuterol inhaler 1-2 times per day. this is down from using it about every 2-4 hours-even through the night.

i guess it was just finding the right mix for me. i'm just glad to be off of the oral steroids....

[1Tulip]

I just found this thread.

First of all... let me say I am relieved it's not just me!!! When I have asthma I "only" cough (until I throw up or feel ready to pass out). My O2 sats are OK and my FEV1's are close to normal, I don't wheeze. So since they can't measure/quantify any problem I must be OK...right? NOT!

Last year I went through 7 months of increasing problems. My doctor would up my prednisone and I'd be a bit better, then I'd get worse. I got steroid crazy and had to go back down to 40 mg/day which I found barely tolerable. I had to go on new type anti-psychotic meds to treat my mania. It was an awful, terrible, nasty, bad time.

Finally the answer was discovered. My HMO had decided I should take a cheaper drug for my BP and put me on a generic ACE inhibitor. I started coughing, got put on steroids, BP went up, more ACE inhibitor, more cough, more steroids and round and round.

Maybe y'all already know this already but... ACE inhibitors cause an increase in bradykinin (an inflammatory mediator) in lung tissues. I didn't know and my pretty darn good general internist didn't either.

If you are an asthmatic with hypertension you must take angiotensin-2 RECEPTOR inhibitors (I'm on Benicar) and should NEVER be on ACE inhibitors.

Just thought I'd share.

Geeze, I thought I was the only one. Clinicians were making me feel guilty i didn't wheeze enough for them.

[SKropat]

Hi..I just read this post on cough variant asthma. I, too, have had this since about 1986. For a year or so, I didn't know why I was coughing like I was or why I was feeling short of breath. Then I heard a patient in Med/Surg who sounded just like me--and I went to the doc and was diagnosed. I also am a nurse and for about 14 years I had no idea what my trigger was. I thought it was everything!! I was on almost all of the same meds you are on--nothing controlled the asthma. Changes in meds...nothing helped. Until I became a nurse, I was only allergic to penicillin. About 6 months into my brand new nursing career, my hands started burning, itching, cracking and bleeding---all withing minutes of putting on latex gloves (I am a labor and delivery nurse so those things were inavoidable). I learned I was allergic to latex--at least
topically. I lived with this for the next 13 years. The hospitals went from powdered latex gloves to low protein latex, no powder gloves---that bought me the additional years until the very last year I worked and I again started reacting to the gloves----so I was given Nitrile unsterile gloves to wear against my skin (but I still had to wear sterile latex gloves over them many times a day). Meanwhile, there were periods where I was almost asthma-free during my nursing career. I stopped to think....I was in between jobs during those times! I did some research and found out that latex allergy can also take the form of respiratory problems like asthma---I knew that anaphylaxis was a definite possibility, but I never, for the life of me, connected my asthma to the latex allergy--until 3.5 mos. before I quit my job. At that time,
I was coughing so much that some night I never slept before I went to work. I was so worn out from coughing that I could hardly move. I knew, given how slow hospitals and clinics were/are to change from using their precious latex gloves, that my career was over. It tore me apart. I still cry a little when I think of the babies I have delivered over the years......but, you know what, I am asthma free now! It took me a long time to feel like I was totally free of it, but I noticed a complete difference in my breathing within 2 weeks of leaving my job. Before I left, a GOOD day was when my peak flow meter read 300. Now I can do 500 with no problem! A total difference. I have had a couple of very minor episodes (like an hour) but that always occurs in the presence of latex gloves at the lab where I get my blood drawn. The techs use vinyl gloves and a nitrile tourniquet but there are open boxes of latex gloves in the rooms. No matter how much you try to teach people about this allergy, some just don't get it! Anyway, the moral of this story is that if you, in your career,
have a lot of exposure to natural rubber latex, you might want to consider this as a possible cause for your asthma. Just a thought.........

Susan