Military asthma

I am searching advice on best medical care to request and questions I should be asking.

Sometime after two deployments to Iraq my allergies went from annoying and unmedicated to crushing and still very symptomatic with medication. My allergist told me that many of my symptoms are from asthma. I've been working with my regular doc and spirometry has shown diminished capacities - but below accepted asthma thresholds. He has not pushed back and said I do not have asthma and agrees that most of my symptoms are definitely asthma. My Army docs have actually been really good - they have seen me over and over and have referred me to every specialist I have requested. I have not been tested after getting onto a treadmill or after being administered the unpronounceable allergic gas.

Related Meds -

Allegra - once in AM
Singulair - once in PM
Symbicort - two puffs twice a day
Nexium - once in AM
Rescue enhaler - everytime before I workout and sometimes after
I have predisone in case things get worse - never taken

When I have issues it is primarily a grating and hacking cough for hours after my heart rate goes up at times it is as minor as I feel an endless need to clear my throat for hours. Obviously this is an impact on staying in physical shape and makes it very difficult to work out. But this also happens if I laugh - to the point where I am afraid to laugh and try to avoid it (which is very contrary to my personality). I also have issue after sex too - afterward I often can not get to sleep for hours while the coughing or the annoying throat clearing thing is going on. That combined with the sleep issues I will about describe have basically destroyed my wife's and my sex life - she's a fantastic lady and will stick by me no matter what - but sex being rare is truly crap on a marriage. It would be more simple if we didn't have two kids and weren't stuck on waiting for them to go to bed. If it's coughing or the throat clearing - an amazing headache almost always follows.

I have much more trouble laying down. I usually sleep on the couch where I can keep myself much more propped up - and where I know I am also not waking my wife up in addition to myself. I wake up in the night choking frequently - sounds like sleep apnea... the first sleep study showed no apnea... but also showed so little sleep that they sent me to a second study. I do not have results from the second study - but since they didn't come into the room in the middle of the night and put a mask on me, they must not have observed apnea.

Sleeping is just awful.

I am always tired. My face always looks like a raccoon with black eyes. The days of me being a motivated and energetic go-getter are past. I now have issues with anxiety and depression.

I have trouble describing my symptoms in an appropriate manner. I am absent some of the more common asthma type issues - I've never wheezed - I've never stopped breathing - I've never gone to an emergency room. I am not convinced that asthma is the correct word for what I have - I definitely have something though. This has been awful for work - I have missed a lot of work for medical in the last year - not just appointments - but also for having a deviated septum corrected and my gallbladder removed. I have been labeled 'the sick guy' in a job where I'm supposed to be a tough Soldier. The doctors have said if my diagnosis gets much further than what it is now they might have their hands tied and have to put me to a medical board (which would risk separation from service). I really don't care though - I'm making my health a priority.

I was an earthmover in Iraq - we weren't just in the dust, we made the dust. There's plenty of research and articles out there about how bad the dust in Iraq is - particularly with heavy metals.

Any advice from your own experience as a patient or a practitioner as to what care I should be requesting and questions I should be asking would be really appreciated! Thanks!

This isn't a very active forum.

Just have a moment to suggest that you drop singulair and switch to Pulmicort. Not every drug works for everyone. If you are not getting adequate management from one drug you should switch.

I have cough variant asthma, too, and except for the first couple of years I haven't every had problems with a peak flow test. I know when my inflammation is bad enough to treat but it won't show up on an office breathing test.

The best criteria I've heard from my DRs about when to use my maintenance inhaler is if I have to use my rescue inhaler more than three times per week. Since my allergies are seasonal, I end up needing my pulmicort for a few months in spring and fall, and otherwise I'm fine. I have learned to be especially careful about respiratory illnesses - if I get a cold I immediately increase my pulmicort dose until the cold is gone gone gone.

You might consider adding a sinus lavage to your evening. Get saline sinus stuff by NeilMed from any pharmacy and hopefully that will help you sleep better. You might also try using your rescue inhaler 30 minutes before you lie down.

Sorry you didn't get more responses. This may sound strange, but my experience is with horses. A lot if our cutting edge treatments in humans come out of the race/show horse world, like the best lung, joint, digestive supplements/treatments available. When horses are in stabled environment, they are exposed to massive amounts of dust, and depending on their geographic location, this dust can contain fungus spores that can reek havoc, like in the desert of the American southwest, coccidioidomycosis, or cocci is caused by the soil-dwelling fungus, Coccidioides immitis, aka Valley Fever. You need to find the "why" inside your lungs to get the best treatment. You need to see a pulmonary specialist who will do biopsies, AND when a lung biopsy is considered, a surgical thoracoscopic biopsy should be obtained, as transbronchial lung biopsies are generally inadequate for diagnosis. Also, since your condition was acquired as the result of military service, you should apply for military VA disability payments, be sure to include all medical paperwork from the military and civilian (you must request copies). Make sure everything is filled out completely, send certified mail, KEEP COPIES of EVERYTHING! The VA can help you with this, you give them a limited power of attorney. NOTE: They will mishandle your request ( entire process should only take six months), so after the six months of runaround, write your eldest, most influential state senator. You will include copies of all VA correspondence, and medical records in the package. Here is the KEY! In the letter, at the end, request that your senator investigate the mishandling of your VA disability claim!! This will force them to process the claim, or go before a Congressional investigative committee! I have helped many other veterans, and wish you the very best!

I think your choice to avoid prescription meds is inappropriate and I hope the pulminologist is able to convince you of this. Asthma is a serious illness that needs to be managed. If you don't manage it you will get worse. People die from asthma.

Ah. yes, I get that. Hopefully the melatonin will help you. Maybe some targeted therapy on learning relaxation methods, too, plus increasing exercise? Although I know you wrote your asthma bugs you when you work out.

I think if you can get control over the coughing (good idea to check for reflux, please try the sinus wash) you will feel a lot better.

You still might want to try elevating your bed at night to see if that can help...do not know if your doing that, wishing you well and the pulmonologist might be the doctor you need ...keep us posted on this...

Yes, these things come and go pretty fast.

The whole thing with you being unable to laugh without coughing, or do exercise - it's all your asthma. I would say that you are not adequately controlled if you still have these issues.

Have you taken oral steroids to treat your asthma in the past?

I had an intractable asthma flare both times I was pregnant and had to use oral steroids to get it under control. Each time a 5 day burst was sufficient.

My dad has worse asthma than me and also takes a beta blocker to control a-fib. He has a heck of a time controlling his asthma and has had to go on steroid burst packs back-to-back a few times during high allergy season.

If you try a dose of oral steroids use your laughing or exercising as a test of whether your asthma is controlled well.

I saw "heavy metals" on the list of bad things to be exposed. I was exposed to chemicals as a typesetter for years, living in NYC and Ho, Tx plus involved in an industrial accident. Figure the pollution in Iraq must have been unreal.

Make sure you discuss heavy metals with the pulmonologist. Take care of yourself as best you can. Asthma is not a psychological illness and can be quite serious.

best wishes to all

Great to see such a thorough review is underway.

Any discussion with the GI about trying another ppi if Nexium isn't doing the trick?

Hope the dietary changes and elevated pillow will resolve a lot of this too.

I just saw your post, and your symptoms sound very much like mine were. It can be hard to diagnose, it took about a year to sort it out for me - GERD vs asthma. Mine turned out to be cough-variant asthma.

If your respiratory tract is also chronically irritated from aspiration, you may need to continue on some bronchodilators until that can heal. Glad to see you finally have some answers and hope you'll soon be feeling better. That not being able to sleep because you cough every time you lie down is the pits.

Judy - I am curious about your similar symptoms you described. What symptoms and testing in particular led to the cough-variant asthma diagnosis? I've been off of my various asthma drugs for about a week now and am getting worse every day. I really am not seeing much as far as improvement with my medication and lifestyle changes for GERD after a week.

I was able to move up my next round of asthma testing, including meth challenge and CAT scans, to late next week. Looking forward to that for hopefully a little more resolution - and to get back onto the meds and stop coughing every eight seconds!

After about 45 days of two 40 mg Nexium a day and extensive diet changes my chronic cough is almost completely gone. Trouble is the nexium is causing a whole host of other symptoms... just another step in the Escher stairs of trying to get to feeling better!

I have had allergic asthma for over 30 years. I am sure I have asthma. I had borderline reflux and did not worry about it very much. Became very sick with a stomach type virus and started belching a lot and then could not breathe.

Being an asthmatic for so long, I am really tired of dealing with doctors so I figured it was just another virus/asthma mess. It turned out that now I have a very mild case of Barrett's. I absolutely love fruit and eat lots of veggies too. I like milk products but avoid meat. I do eat it sometimes.

Soda is meaningless to me, as is alcohol and cigarettes. I do drink coffee though. I like iced herbal tea or hot herbal tea in the winter.

Now I am trying to lower my pain med to 7.5 and taking 300 milligrams of Rantindine (spelling) at night. I take 40 mg of omeprazol and wait 20 minutes to 30 hour and then eat and take the 7.5 pain med.

Have VERY SEVERE arthritis and the whole thing makes me tired, pain, asthma and worry.

Doc said that the barrett's does not go away but it is very mild. Hope it does not get worse.

take care everybody ... both of these things (asthma and barrett's) are serious and deserve our best efforts.