Another asthma flare- I'm getting frustrated.

01-21-2011, 08:13 AM

Thanks. My office is on one end of the building, but the construction is smack in the middle on all levels.

Hard to avoid the bad air outside as well. There is a chance of rain this weekend. I'm hoping it actually happens. Maybe it can stir up the air enough to clear things out. When whe go a while without rain, the air gets "heavy" with pollution particles. Looks like a brown haze against the mountain.

I'll be taking my air purifier in to work, but I have meetings throughout the building so I'll only get the benefit during the limited time I'm in my office.

School is starting up and we've got over 700 preschoolers and their parents getting ready to invade. Lots of things going on in order to make this successful. I can't afford to be constantly sick.

Here's to hoping we get through the next several weeks successfully!

01-21-2011, 12:24 PM

Yeah, it might be mask time. I know next April I'm going to be using mine shamelessly!

01-21-2011, 01:24 PM

So I'm still seeking answers to my cough. I had a 24 hr pH test that ended today. This one was a bit different in that the probe was positioned just above my vocal corRAB behind my uvula. This reaRAB any acid that may be in vapor form coming up past my vocal corRAB. I won't get the results for a week, but I did ask the doctor what kind of readings I might need to be concerned about. With this kind of test, the ideal normal pH in the throat is around 7. Last night I averaged between 6.2-7.2. However, I woke up and it was in the 5's. I was in meetings most of the day and I was in the 5.5-6 range. The doctor said that wasn't normal. That means I still have acid coming up and irritating my throat and probably still triggering my asthma. This is really frustrating to me. I had the reflux surgery a couple years ago. My EGD and Barium Swallow show the surgery is holding and showed no evidence of reflux.

He will sit with me in 9 days to go over my results, but it sounRAB like I might be adding yet another PPI to my regimine on top of my already high dosage. I went from taking Prevacid 30mg twice per day to taking dual delay time release Dexilant (formerly Kapidex) and have remained on it for years. A couple weeks ago, I added Pepcid at night as well "just in case". Adding another PPI at night will be the equivalent of taking 3 high dosage PPI's per day. I worry about the side effects, but I also need to balance this with the breathing concerns.

In my search for answers, I also have an appointment with my Pulmonologist tomorrow and an MRI Thursday.

Hopefully next week, I'll have more answers. I'll have my pH and MRI results from my ENT and my EGD and a couple biopsy results from my GI doc. I'll also have some direction from my Pulmonologist.

Thanks for your support in my journey. It really does help. I hope I can return the favor at times.

01-21-2011, 01:55 PM

Mountainreader, I am sorry to hear you are having such a bad time, summer should be your time! Just a thought, could it be that stress is playing a part in this? I know that stress and just plain being upset because you are having asthma now when you shouldn't be, can trigger it, so try relaxing (easier said than done) but do try seriously relaxing, and don't let people get to you, they are not always going to understand asthma. It is like fibromyalgia, if they cannot see it, they don't understand. I have both and I just don't talk about either one to frienRAB anymore. Remeraber that emotions can bring on asthma, it did in me as I was growing up. Take care and relax.

Sunny

01-21-2011, 03:54 PM

Yes, a hemoglobin score like that is pretty low. Unless you've been eating a very limited diet, there's probably a reason for it, that you are either losing blood or not absorbing iron properly. And, absolutely, anemia can make people feel short of breath. Maybe investigating that will get you some answers.

01-21-2011, 04:37 PM

Hi SureBett,

You are right about the moving. I developed allergies as an adult after I moved to Utah 15 years ago. I'm now a couple years into my second go-round of immunotherapy. Currently getting 2 injections weekly for 28 of my worst allergens. Thankfully, they are really helping. While I do have allergy symptoms, they have been fairly mild most of the spring/summer this year. I also started Xolair injections for allergic asthma a few months ago. Most of my asthma triggers are environmental, but my bloodwork came back such that it qualified me for the Xolair. I know when I travel I end up with allergies to something wherever I go though. It is pretty much just a given.

When I talk about the moving, it is in frustration. I've had multiple years now where I've had asthma flares that I couldn't get under control for over 4 months at a time. That typically lasts from Noveraber-May. Because it is starting this early, I worry I'll already be aggrevated when winter hits. I just don't know how long I can physically and mentally handle this. Winter and cold air are my worst triggers. Pollution and other environmental things such as cleaners, perfumes and smoke are also triggers for me. Unfortunately, I live in a mountain valley area that has cold winters and typically develops winter inversions (pollution trapped in the valley) which means horrible air quality. Without moving or vacationing, I can't get away from breathing the stuff. Summer is usually my "safe" time of year. There are times I feel I would be better off moving somewhere warm with low humidity. A lower altitude might help as well...who knows.

It is frustrating for me getting the PFT testing. It takes me months to get an appointment with my Pulmonologist and another month to get scheduled for testing. The last several times I was tested, I was feeling just fine and my results were normal. Frustrating that the doc can't see me when I'm having problems. I'm on so many meRAB I don't think my PCP knows what else to do with me.

Right now, my wheezing is better, but I'm spending about 40-50% of my day coughing and trying to get a good breath. This is despite Advair 500/50, Singulair, Prednisone, Albuterol (inhaler and nebulizer) and Tessalon Perle (for the cough reflex). I'm physically worn out. I've also pulled some stomach and back muscles.

On the flip side, I've had some years where following my asthma action plan has worked wonders and I've been able to get things under control fairly easily. Just not recent years. The mask thing is a real pain, but I've decided I don't care what others think, I'm wearing one if it helps. I found a company on the internet that has cloth masks with special air filters that have helped me. They make a fleece version that I use in the winter and cloth version that can be used in the warmer weather. Not too pretty, but they get the job done. Also great that they are washable.

I do have "silent" acid reflux with both GERD and LPR. My reflux symptom was a cough and flare of asthma. I was able to keep it under control with diet and PPI's twice a day for many years. Unfortunately, about 3 years ago everything just stopped working and I had a reflux triggered asthma attack that required emergency treatment. I ended up having reflux surgery in 2008. So far, it has worked. At least I'm just dealing with environmental asthma right now and not the reflux as well.

I'm glad to hear that you have a supportive husband. Going through this alone is tough.

Here's to hoping tomorrow is better.
MountainReader

01-21-2011, 06:06 PM

I met with my ENT/Allergist today. He gave me a breathing exercise to help with the cough. He really wants me to focus on reducing my vocal cord inflammation. He said I was doing everything right as it pertains to my asthma, allergies and reflux.

That said, he reviewed my pH test I had last week while still taking my reflux meRAB. This test measured the acid that is actually making it up into my throat. Turns out that despite reflux surgery, a double dose of PPI's, sleeping on an incline and watching my diet, I'm still refluxing frequently. I literally spent 46% of my night between 2 & 6 a.m. refluxing with one event lasting 55 minutes. I had 102 reflux events during the testing. My pH RYAN score was 106.17 and anything over 9.41 is considered abnormal. All that reflux is why I keep coughing and having asthma symptoms.

My frustration: I had reflux surgery 2 years ago. I took this test while already on high dosage PPI's and while following other reflux treatment strategies. At this point, my ENT said there wasn't anything more I could do as it pertains to my reflux because I was already doing everything right. I happened to have a GI appointment a couple hours later. My GI doc wants me to add another dosage of Dexilant. Dexilant is a dual delay time release PPI and one 60 mg pill is the equivalent of two dosages of other PPI's. In my opinion, taking 2 Dexilant is the equivalent of 4 dosages of PPI's. I worry about the effects of that. I'm pretty certain my insurance won't cover this either and I can't afford the cost of the PPI's out of pocket. (If I took OTC Prevacid, I'd have to take 8 a day for the same dosage.)

On the good side, my biopsies and MRI came back normal.

01-21-2011, 08:04 PM

Perhaps a week off with a bottle of Cheratussin would do the trick? You're lucky it makes you drowsy...codeine hypes me up and I have to take a benedryl to sleep on it!

01-21-2011, 08:08 PM

I've noticed that, too, that a warm shower sometimes makes things worse, so I try to keep the shower short (including having water on only to wet my skin beforehand and rinse after) and I keep the bathroom vented if I'm having a bad day. The other day, a giant billow of hot steam almost made me stop breathing entirely until I got OUT of it. But very dry heat or dry cold can't be good, either.

For lungs to function at all, they have to be damp but not too damp, so I guess breathing air with the RIGHT amount of humidity is best. I wonder how much humidity is ideal?

**snowdrift** · 01-21-2011, 08:53 PM

MountainReader, is there any way you could switch pulmonologists?

I do know that wait times in my area are not as long as they are in many places, so I don't really know what a realistic expectation is, but if consistent long delays in testing and treatment are preventing you from getting and keeping good asthma control, it seems like the pulmo is counter-productive.

It did take me a couple of months to get in for my initial pulmo appt, but since then when I have an exacerbation, I can usually get in within a day or so, or he or his staff will consult on the phone and call in a scrip for prednisone or the appropriate antibiotic.

Last time I did have to get insistent. After the full gamut of IM/oral steroiRAB and neb treatments, I was still getting worse every night and taking all day to recover a little. The receptionist kind of blew me off because I had already had Urgent Care and ER treatment, but I insisted on talking to the PA, and she got me in the next day. It was a sinus infection preventing things from getting better, and several days of abx cleared it up. I won't usually take antibiotics for asthma-related problems unless prescribed by the pulmo, because I am concerned about long-term problems from abx overuse.

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