Cough Variant Asthma

Posted in another thread and got a bunch of questions, so I'd thought I'd start a new thread and give a little more info.

I have adult onset cough variant asthma that has been a pain to control. I was diagnosed about 2 years ago though I've had symptoms for about 3 years. I did not grow up with asthma. My triggers are strong smells, perfumes, smoke of all types,dust and temperature extremes (like going from AC to hot and humid or heat to freezing cold.) The perfume issue alone is probably my biggest problem. I have problems several people at work who, when asked to refrain from wearing perfume, basically said screw you. It's also a big problem for me at church (or the movies or anywhere with lots of people). Some days I am just plain scared to leave the house, for fear of having an attack.

I'm not allergic to anything that the doctors have tested for. My tests are all normal (no reactions to anything on the scratch test (other than the control), negative RAST test, and no measurable change to PEV in the Methacholine Inhalation Challenge test) but I've been coughing for almost 3 years now. In the doctors office I have had some minor variations in my spirometry but nothing that isn't normal for a "normal" person. Blood Oxygen is always 98 -99. My cough is almost always somewhat goopy and semi productive. Had sinus CT and hi-res chest CT and nothing was abnormal, other than a slightly deviated septum. I've stumped 6 doctors so far. I just keep trying new drugs (and doctors) in the hope that it will help.

Currently I take 1 dose of Sprivia and 1 puff of Advair 250 in the morning and 1 dose of Advair 250 in the evening. I've taken the Advair for about 3 years and the Sprivia for about a year. I have just added Asmanex 2 puffs before bed. And am taking a high dose antibiotic for 2 weeks to see if that does something. I also have a ProventilHFA inhaler which I use as needed. Which lately is just about every day. (I have a friend who has asthma and we always seem to be messed up and sick at the same time.)

In the past we have tried Singulair and it didn't so anything for me. I've done 6 months of GERD drugs (Protonix, Nexium, and Reglan) to see if that was part of the problem. They made no difference. Was on Zyrtec for years before this started but no longer take it as it didn't seem to be doing anything.

Always open to ideas and suggestions for things to try.

Gosh Bluedog, it sounds like you are working with some real considerate people.  I have all the same asthma triggers as you. I am 56 years old and my asthma came on with a vengeance about five years ago.  When I was still working, people were considerate, after they saw me have asthma attacks or saw me go into panic modes trying to find out who had on the perfume before I had an asthma attack.  I can't handle scented candles either.  I worked at a university and if I smelled a candle that was bothering me, I would just go up and down the hall until I found it.  Everyone knew how bad my asthma was and didn't mind to help me.  It doesn't sound like the group you work with.

How large of a group of people do you work with?  At this point, I wouldn't care if it made them mad, but you need to get your doctor to write out a note, it can even be on a prescription pad, the things that trigger your asthma attacks and that you can not work around these things.  The ADA protects people like us, even if they have to put you in a little office all by yourself.  I bet that will put a little pressure on boss to talk to the other people about leaving the perfume at home.  I also understand your dilemma at church.  There will be times when I will sit down and then move a couple of times.  It used to embarrass me, but now I just do it and down worry about what people think.

Do you feel like you have GERD symptoms?  I know this can trigger asthma, but I think you would feel the reflux.  I had my esophagus and a hiatal hernia repaired a couple of years ago because my doctors thought that could be triggering some of my asthma attacks.  If you think you have GERD, have you had a thorough work-up by and GI specialist?

My lap Nissen did help my asthma some, but it sure did help the GERD.

I think the medication that helps my asthma most is the Xolair injection that I take every 28 days.  I think I have been taking it for about four years.  As severe as my asthma is, I have had only one ER visits and no hospital stays.  Do you have a nebulizer to use at home?  As Char mentioned, I also use Xopenex in my nebulizer.  Most asthma patients seem do better if they are treated by an allergist.

Please keep us posted.  I'm not a doctor either, just another asthma patient.  We are here for you and we care about you.

Feel better!

Carla

Awe bluedog, wish I could help you, sounds like you've been thru the wringer. Sorry!
I wish you good luck and hope you'll get that cough under control soon...........

I don't think sulfates are a problem for me. I take albuterol sulfate pills when I get bad and I would think that they would cause me more problems if that was the case.


Good news:
It's been about 2 weeks since I started Asmanex and it seems to be helping. I was using my rescue inhaler at least once a day and now I haven't touched it in over a week. I also just finished a round of antibiotics. But now I seem to have gotten a sinus infection. Oh well. You win some you lose some. At least it's not bothering my asthma... yet.

Wow sorry you have been through so much. But it somewhat sounds familiar to me. I'm 23 and I was diagnosed with asthma 8 months ago so I am still pretty new to all of this. I was diagnosed with exercise-induced asthma and starting to wonder if I have cough variant asthma. My triggers are also strong smells, perfumes, smoke, weather and temperature. As soon as the weather changes I have flare ups I can even tell when its gonna storm...when the air changes I start coughing uncontrollably. But it no matter what it seems like I have a permenant cough and its usually somewhat productive. If I start having a cough attack I can use my inhaler and it helps it. I see a pulmonary specialist but have not made it back to see him (being a college student makes it hard). But hopefully soon I can and get started on a daily med for better control and I wont feel so tired all the time.

I think I have cough variant asthma too. I cough non stop...it's a dry, unproductive hacking cough and I have had if for about three weeks. Last year, I got the same cough (no othe symptoms) and it lasted for weeks. When I lived near Washington, DC, I had a cough that lasted for months; it went away suddenly when I visited my family here in SC.

I have been to my family doctor over and over again. She prescribed Levaquin (antibiotic) and Tussionex (cough syrup). Neither helped. She then referred me to a pulmonary doctor who told me he believes I have cough variant asthma and allergies. He prescribed Allegra, Advair 500/50 and Albuterol inhaler. That was about two weeks ago. I have not taken the Advair because I could not figure it out (I felt like I wasn't getting anything). The Allegra and Albuterol alone have not helped. I went back to my family doctor yesterday, and she showed me how to administer the Advair, and she told me to take it twice a day - 12 hours apart for a few days and go back to see her. I know the Advair takes awhile (or so I'm told), but I've taken three doses since I saw the doctor) - and nothing so far.

I'm coughing all the time. I am going to a new pulmonary doctor next week, but I don't know what to do. BTW, no other symptoms, just a dry cough. Sometimes it feels like it's in my throat.

I'd like to know if anyone else has had a similar experience with their initial diagnosis. I guess I want to know if there's hope that I will stop coughing one day!

GirlNCarolina,

Welcome to HealingWell!  I think going to a pulmonary doctor is a good idea instead of your family doctor.  Most people with asthma who are treated by allergists seem to do better and a pulmonologist is great also.  You are not going to see any relief from the Advair in just a few days.  So, I am glad you are seeing another doctor.  Please keep posting and let us know what you find out.  I use Adair myself and consider it a very good controller medication.

Take care!

Carla

Sandee,

Please let us know what you find out.  GERD could certainly be a possibility also.

Take care!

Carla

I'm glad I found your post. I have CVA, worsened at work and exercise. I've used antihistamines (all), allergy shots/testing, food trials, singulair, Advair, all nasal steroids and Astalin (anti-histamine nasal spray.) I even had a deviated septum repair to see if it would help. The only real relief I get which is temporary is from suppressants like Tussinex, which knock me out, or brochodilators, like albuterol, which makes my heart thump like mad when I take it more than every 6 hours. I recently started Pulmacort and Brovana (spelling?) via nebulizer, which after 2 weeks has made no difference. I'm sick of a chronic low grade cough, chronic post nasal drip and constant clearing of my throat as well as the 1 to 1 1/2 month long hell I get if I get a cold. I cough more than I don't. I work with people in the service industry and I am tired of seeing them recoil like I'm a leper and have to apologize for my constant hacking. Most nights I'm sleeping on the couch to keep my wife from waking up. And I don't want to end up with COPD without ever having smoked a cigarette in my life.

I was considering alternative therapies (such as herbal.) But there are so many products and I'm concerned about interactions, side effects (lifelong), purity, and toxicity. I have not seen a holistic doctor, as i want as much input as possible first. Any of you heard about a particular product that's good or herbs in particular?

Jefe22,

I have severe asthma and I can not use Albuterol.  It makes me race and my heart pound as you described.  I use Xopenex in my nebulizer and they now make Xopenex in an inhaler.  None of the other inhalers did anything for me.  When I have the coughing fits, two puffs of the Xopenex inhaler and I am fine.  I am 56 and have only had asthma for six years.  I can be out in a restaurant with friends and start laughing, which leads to coughing and wheezing and they have been amazed how much better this new inhaler is working for me.  You might want to talk to you doctor about using Xopenex in your nebulizer also.  It sounds like you are having as much trouble with Albuterol as I did.  I wouldn't be able to talk for a few minutes after I would use it, my mouth would feel all numb and weird.  I know the majority of asthma patients use Albuterol.

Take care!

Carla

allergyqueen, Welcome to HealingWell.  I am sorry to hear that your five year old is now suffering from asthma as well.  I'm sure that must be tough to watch.

Please know that we are here for you as a support system.  We are pretty much like a big family around here and we are very glad t have you join us.  Please keep us posted as to how you all are doing.

Take care!

Carla

greyhoundgirl, Welcome to HealingWell.  You will find that you are not alone in suffering from this disease.  GERD can definitely trigger asthma.  Have they done any of the test for GERD yet?  I ended up having my esophagus and a hiatal hernia repaired about three years ago because it was really triggering my asthma.  I had enough going on with the asthma with out adding this extra trigger.  Do you see an allergist for you asthma?

Welcome to the family!

Carla

greyhoundgirl,

GERD can sometimes be caused by food sensitivities (non-allergic reactivity or enzyme deficiency). Do you sleep on a wedge or with the head of your bed raised 6-8"? I had GERD for a long time only to discover it was caused by sulfite sensitivity, food allergies and intolerances. Also, there is a condition called Eosinophilic Esophagitis (EE) that can co-exist with Asthma (Asthma & allergies are more common in people with EE than in the general population) and one of the primary symptoms is GERD that doesn't respond to anti-reflux therapy. Surgery for reflux won't help EE and may make it worse. Check out http://www.apfed.org/ for more information about EE. My Husband has Eosinophilic Gastroenteritis and Esophagitis and Asthma, and I've been to some of the patient education conferences and read a lot of information about these Eosinophilic Gastrointestinal Disorders. Researchers studying Asthma were trying to give Asthma to mice by stuffing mold up the noses of the mice, which worked but the mice also developed Eosinophilic Esophagitis from this. So any time someone has GERD that is bad enough to consider surgery & has Asthma, I think EE should be ruled out...but that's just my humble and very biased opinion, LOL.

Take care,