Asthma vs. Bronchitis... What would you do?

In My Humble Opinion
1

Here’s the situation fellow Dopers…

A few weeks ago I developed a sore throat and a cough. Like any normal college student after it became too much I went to the health center.

There they initially diagnosed my condition as bronchitis. The doctor that I saw perscribed doxycycline (an antibiotic) and Prometh with Codeine cough syrup. I was told to return in two days if I wasn’t feeling any better.

So, two days later I returned because I was still coughing violently and I wasn’t feeling much better. At this point they began to suspect that I was developing asthma, mainly because I display most of the symptoms of asthma coughing, chest tightness, shortness of breath; however I don’t really wheeze ( I only wheeze when I cough). At this point the doctor also perscribed Advair to try and open up my lungs. Since they were suspecting astma they started to take my peak flow ( the measure of my ability to push air out of my lungs) and my blood oxygen level. I had never been diagnosed with asthma, so all of this was very new to me. They asked me to come back the next week.

That night my grandmother took me to the hospital because she thought I that I had bronchial pneumonia and lack of oxygen, because I had a severe headache. At the hospital I had several doctors listen to my lungs and all of them asked me if I had asthma. They took chest x-rays and they all came back clear. They recommended a cool mist humidifier, told me to continue with my medication and sent me home.

The next week I returned to the health center, at this point I was feeling really good (finally finished with the antibiotic and the cough syrup), but my coughing was and still is really severe (I often cough to the point of gasping for breath). The doctors there continued to test my Peak Flow and blood oxygen level. During the week my peak flow never went above 200, when at my height and age it should be around 460. Needless to say at the end of the week they concluded that I have asthma, so they added an Albuterol inhaler to the medicine mix. They also want me to see a Pulmonologist.

Here’s where it get’s tricky: My family in no way shape or form wants to believe that there is the possibility that I could have asthma. They merely think it is just a cold. And I’m not saying that there isn’t the possibility that they could be right. That is why I saw my family doctor for a second opinion. What I didn’t know was that my mother had already discussed this whole situation with my family doctor.

I had the health center fax all of my information over to my family doctor, so he could get a better understanding of what was going on. When I saw him, he merely listened to my lungs and went by my temperature of 99. 1, and told me that I have a case of bronchitis that is continuously irratated my my constant coughing. He said it couldn’t be asthma because I have a fever. But that is the first time that I have remotely had a fever in all the time I have been going to the health center. So he perscribed Tussionex cough syrup and Prednisone.

I wouldn’t be so doubtful of his decision if it wasn’t for the fact that he didn’t really look through the records I had faxed over and he didn’t really care about my peak flow record. I was only in his office for about 15 minutes, tops. I know he could be right, that this is merely bronchitis and I also know that the health center could be wrong with their asthma diagnosis. So now, I am on even more medicine and really unsure of what to do. Tomorrow I have a health center appointment with their asthma specialist. Even though, my family doctor says it’s bronchitis, I plan to keep the appointment.

What would you do if you were in my position? I don’t want to assume either way and I really would like to be able to stop coughing. If you have any idea of what I should do I would be really interested in hearing it. Thank you so much.

2

My personal doc spends a lot of time with me. He even diagrams stuff if I don’t understand. I’d get another doc. I’d keep the appointment with that asthma specialist. I don’t think any of your family members are M.D.s. Good luck!

3

Go to the asthma specialist and have a good long chat with him/her.

Consider getting a new general family doc. I’m concerned that he didn’t look at your peak flow. 200 is low. I speak as a person with asthma, not as a person with medical training.

I don’t know why your family refuse to countenance the possibility that you have asthma - it’s not like it’s the bloody bubonic plague!

Hopefully if the diagnosis of asthma is confirmed, you’ll be prescribed a reliever inhaler (such as albuterol or salbutamol, to quickly open the airways when they’re tight) and a preventer inhaler (a steroid, such as beclomethasone, to take twice a day to prevent the airways getting tight and inflamed). This medication programme keeps everything nicely in check.

Prednisone is a steroid used as a strong anti-inflammatory. I’ve been prescibed this twice in order to quell inflammation in particularly bad asthmatic episodes.

Good luck with your specialist and with your family doc (and don’t hesitate to change the doc if you don’t get the treatment you need).

4

It couldn’t be asthma because you have a fever? And he didn’t even look at your records? Arsehole. Give this specialist a go.

Every asthmatic episode causes a little more irreparable damage, to your airways so you don’t want to let it go any longer than you have to.

Others have named a few different drugs and I’ve tried most of them. None of them worked until I took part in the Australian drug trial for Serevent and Flixotide. They were almost miraculous and eventually they combined the two to come up with Seretide (creative naming, eh?) Ask your respiratory specialist about it although everybody’s asthma is different and require different management plans.

Anyway, it’s all behind me now. Completely drug free (excluding caffeine and alcohol) for eight months and counting. I’d heard about the Buteyko Method through my ex who is an asthma researcher. I also got into the drug trial through her so I guess she wasn’t totally the spawn of Satan.

Essentially, it’s a regime of breathing exercises developed by a Soviet scientist in the seventies I think. It’s difficult for some (definitely was for me) but is worth it. Many people lose any reliance on drugs whatsoever and most find dramatic improvement in their lung function stats.

Now coming from an extreme skeptic of any medicine smelling of alternative, I have to say this is the real deal. Do some searches on it. The spelling is correct although I’m not definite about the two drugs I named or even if they have the same brand name in your country.

Ideally, you’re just being hypochondriac and you don’t have asthma at all. If not, the I hope this provides a good avenue of investigation for you or anybody else reading this who is afflicted by asthma. Good luck in either case.

5

I went to the Health Center today to see the asthma specialist, and I have to go back later on today to see the doctor. They weren’t too thrilled with how my family doctor handled all of this. They were also really confused that my doctor would put me on Prednisone, because that is used to treat asthma, when he doesn’t think that I have asthma. They don’t like the fact that he has me on the Tussionex, because it has hydrocodone in it which makes me really sleepy and a virtual zombie during the day. Since I am a student being a zombie during the day just isn’t good.

I really appreciate and value all of your opinions. Thank you all so much. I’ll update you when I learn more.

6

I have asthma, over the last six months I have had a particularly difficult and unusual exacerbation requiring multiple antibiotics, multiple sterods-IV, by mouth and inhaled, and a multitude of side effects caused by all the antibiotics and steroids. I am also an RN who worked for 10 years on a pulmonary medicine floor. I am telling you all this so you can appreciate how I understand the disease of asthma so well.

I had a few asthma episodes when I was a child and nothing else until I was in my 30’s. Then I would only wheeze if I had a bad cold or bronchitis. Then all of a sudden something triggered this flare up and I just could not get over it. After numerous visits to the family doctor with no relief I ended up in the hospital on massive doses of iv steroids. I started on 250 mg of solumedrol every 6 hours and tapered off from there. Believe me this is a huge dose. I also started seeing an excellant pulmonologist but every time I would stop the steroids-up to 80 mg of prednisone a day, the wheezing and bronchospasms would come back.

Finally after a full six months with no progress with regards to the asthma but now with pulmonary hypertension and heart failure I was referred to a rheumatologist who specializes in allergies and respiratory patients. She determined that I had an anaerobic infection in my sinuses that was sort of trickling down into my lungs and it was causing the asthma. Within a week of beginning new treatment for the sinus infection I started making an almost miraculous recovery. I have not needed a breathing treatment in over a month, my peak flow is 450 every day and I can run up a flight of stairs with no problem. I take one puff advair a day, 180 mg of allegra and flonase nasal spray for the sinuses and 10 mg of singulair for maintainance.

But enough about me. I am convinced you are having bronchospasms probably brought about by the bronchitis. It is possible to have either bronchitis–meaning an infection of the bronchial tube, or asthma-meaning spasms or narrowing of the brochial tubes or you can have both together. Usually if you are not running a fever and the sputum is white or clear then you probably don’t have an infection.

Your persistant cough is very likely be due to the asthma–it is your body’s way of attemping to open the tubes. If that is the case then the cough syrup probably isn’t helping much. So what to do? Definitely continue the advair-it is a combination of serevent and flovent. It may take some time for the inflamation to calm down to where you are no longer having symptoms but don’t stop taking it cause you don’t think it’s working. Your doctor may need to increase the dose to twice a day. Use your albuterol inhaler every 4-6 hours, it is a bronchodilator and will help with the coughing as well.

I am not sure why your family refuses to believe you have asthma. Do they think it is some mythical condition that a person can control at will? Do they think that you could just stop wheezing and coughing if you wanted to? If anyone has any questions about whether asthma is real or not, I’d be glad to talk to them.

Disclaimer, although I am an RN, I am not a doctor and any comments I make are purely anecdotal; they are not intended to replace the advice or orders of your family physician.

7

I was diagnosed with asthma last year. I’ve since figured out that I’ve had it a long time. My respirational therapy guy says most asthma goes undiagnosed until the patient really gets in trouble or has surgery. My local hospital sponsors a free asthma clinic, or class. I learned a whole lot. I used to think all asthmatics wheeze, but the primary symptom is coughing. I used to think asthma drugs are only for attacks-in-progress. You can do it that way, but it’s better to control the inflammation phase continuously (the inflammation drugs work more slowly.) The rescue drug is for the bronchial spasm phase. It works quickly, but if you have inflammation, untreated, the rescue drug may not be enough to keep you out of the hospital.

The fact that you have a fever and bronchitis does not preclude the asthma.

I was taught to keep track of my peak flow numbers, and adjust my drugs accordingly.

8

You could definitely have both asthma and bronchitis at the same time. I do it all the time, myself. Also keep in mind that asthma can predispose you to other lung problems, like bronchitis and pneumonia.

Don’t let your mom diagnose you, and if you aren’t satisfied with what the doc says, find another one. Repeat until satisfied.