Asthma, acid reflux or something else?? Help
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Sorry in advance but this will be a long post. Im 23 yrs old, f. Diagnosed of asthma since i was a child. I could have no asthma attck for months but when i do it is worse. Im not currently taking any maintenance before this started.
Ive had an asthma flare up last month (March 2016) due to sore throat and cold. I've went to see my doctor and he prescribed me Symbicort, Albuterol neb and Z pack. Usually, this medicine combination would work for me but this time it doesn't. After finishing my Z pack and see only a little improvement I went back to him and this time he prescribed me a Medrol pack. It helped with my breathing but not completely. I know there is still something wrong.
I finished my medrol pack but coughing and difficulty of breathing is still there. I have night sweats when I started Medrol and got a tinge of blood in my phlegm twice so he ordered chest xray cause he was thinking that I might have TB but chest xray is normal.
I've went to see him again after finishing Medrol and he prescribed me a second round of Z pack because my phlegm became yellow every morning.
Again, I've finished Z pack and nothing has improved except the color of my phlegm. I'm getting frustrated and anxious that time cause I don't know what is happening to me and why the medicines are not working.
The following weekend I was supposed to travel but I'm monitoring myself if my body is strong enough or not. Symptoms are still there so I decided to go to an Urgent Care because I cannot see my doctor soon enough. They prescribed me Prednisone for 7 days and a cough medicine. Unfortunately, I cancelled my flight because I'd rather not compromise my health. I went to my doctor for the nth time and every time he listens to my lungs it was perfectly fine but I would explain to him that my back is tight and I am still experiencing difficulty breathing. He can't even explain what was happening. He just told me to continue Symbicort and that's it. I was asking if he would add another or change my inhaler but he decided not to.
I decided to go to an ENT to have my throat check due to recurring sore throat and he performed Endoscopy and he said that I don't need to worry about my throat cause it was fine. He mentioned that it might be acid reflux that causing my throat irritation. He didn't prescribed anything but he advised me foods that I need to avoid.
I went for a second opinion for Pulmonologist and they performed PFT. The results were ok. Lungs are cleared and the doctor told me that acid reflux might be the underlying cause of all this. She also told me to stop using albuterol neb (I'm using it day and night) cause it might be causing the acid reflux and only use it whenever needed. She prescribed Pantropazole 40mg once a day. She also ordered some blood work if I have any allergies and because I told her I'm still having night sweats despite that I already finish my dose of Prednisone. Again, they wanted to rule out the possibility of TB.
I'm still on Symbicort and on my 6th day of Pantropazole and I don't see any improvement. I could have chest tightness or back tightness for the whole day everyday, it's either one or the other. Along with the night sweats, I would wake up very early (around 4 or 5) everyday with chest tightness or sometimes dry mouth and phlegm stuck in my throat. I only drink water or herbal tea since i got sick. I try to eat healthy and avoid foods that can cause acid reflux. I don't know but sometimes I'm skeptical if this is really acid reflux or something else. Sometimes I would think that there's still an infection left from my sore throat and cold from the beginning. It's been 7 weeks and i'm getting more worried. I forgot how it feels like to breath normally 
I'll have my doctor's appointment again on the next two weeks. Has anyone experience same symptoms??
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Annaflare Seeeri
Posted
A couple things to ask, what dosage symbicort are you taking, how many puffs and how many times of the day? What is the maximal allowable dose that you've been prescribed. It can take a good week or two of Consistantly using symbicort for it to start having full effect.
I used to have severe Astma, but now with the new drug classes, it's been re-classified to moderate, difficult to manage. Symbicort by itself doesn't help me completely I'm on 200/6 upto 12 puffs a day (100/3 is a childs dose)... 2 morning, 2 afternoon and 2 evening. with an additional 6 during the day if needed (ventolin puffer after that). On top of that I take Spiriva of a morning. That combination predominantely keeps me managed... if not then I sart breaking out the Alvesco 160ug... with Ventolin and Atrovent nebules if needed. Escaluating further, if that all doesn't help then I start breaking out the prednisolone at 37.5mg.
Reflux can cause Asthma. The question is do you suffer reflux and heartburn? Are you aware of your triggers? Could be pollens, plants, pet hair, cold air, petrochemicals (if for example they've been laying down new tar recently where you live or work) among many many other things. Have you ever had a skin prick test done and have they tested for Aspergillus (a type of fugal infection) which can cause persistant asthma (blood test). It can be treated with Itraconazole.
The blood allergy tests can be rendered somewhat ineffective at greater than 30mg hydrocortisol equivelent (a bit over 5mg of prednisolone).. and are completely useless if you've been taking antihistamines in the previous 7 days. Though chances are you would've been told not to take antihistamines in the lead up to it.
Are there any molds where you're living, they can wreak havoc with your lungs too. Judging from what you said, it sounds like you had a chest infection of some type. Being Astmatic... it can take a number of weeks to months for your breathing to get back to normal after a chest infection. I've personally had it take a number of months in the past.
Here's another question, are you tighter breathing in... breathing out? How much stress have you been under lately? Studies have shown that stress can cause an increase in severity of Asthma... there is also a condition called Vocal Cord Dysfunction... they can sometimes pick it up during spirometry (in the cabinate when you're breathing into that machine) testing. A number of Asthmatics have VCD as a comorbidity. The characteristic of VCD is tightness while breathing in and it can often be mistaken as being Asthma, only the typical medications don't treat it effectively.
Another question, has anyone tried doing a throat culture, to see what the infection is. Prednisolone is contraindicated where there might be a fungal infection (becuase it suppresses the immune system at higher doses).. not something most people have to worry about, it's less of an issue during shorter courses as well. Prednisolone is a whole body freakout drug, it has the potential to affect every system in the body. It could easily account for the night sweats, even if you have finished the course.
Drink plenty of fluids to try and break up the mucus in your throat. It's possible that another antibiotic may need to be tried, The bug you have (assuming it's bacterial) could be resistant to the Azithromycin. You've been sick going on a month (if not a little more), something is going on. The ant acid is likely going to reduce the effectiveness of any medications and nutriant absorbtion... due to the lowering of stomach acid.. unless you have genuine reflux, it could cause more problems then it's worth. Consider trying Doxycycline, which is one of the few antibiotics I'm able to actually take. But really, they need to isolate whether it's bacterial, viral or fungal and treat appropriately from there. If it's viral there's not a lot can be done.
Seeeri Annaflare
Posted
First of all, thanks for responding. Your insights are really helpful. And I’m sorry to hear that you have to deal with your asthma and all those medications. I’ll try to answer each of your questions.
I’ve started to take Symbicort 2 puffs 2x a day since the first day I got sick last March (I have a Symbicort stock in my medicines from my previous flare up last year). I take it religiously and haven’t missed a dose. The dosage is 160/4.5mg. When I called my doctor before, telling him that I still have difficulty breathing he said to take it also in the afternoon but I stick to 2x a day because I don’t want to be too much drug dependent. My condition is not getting better nor getting worse, but there are times in a day especially after work that my chest tightness is more prominent.
The whole reflux thing is new to me until recently when I’m doing my research and when the doctor mentions it to me. Sometimes I’m convinced that I have one, sometimes I don’t. I honestly don’t know how heartburn feels like because what I’m feeling is like there is something blocking in my chest. The discomfort is from my throat (between my clavicles) down to my sternum. My definition for heartburn is there is pain in your chest. Please correct me if I’m wrong, I’m still naïve with this condition. I’ve been burping a lot too where the doctor told me could be another symptom.
The only trigger that I’m aware of is change in weather, cold air and viral/bacterial infection other than that I’m not sure if pollen or plants triggers me. I’ll find out on my next appointment. I really haven’t had any test except for blood test, chest xray and PFT.
I’m not taking antihistamines or prednisone when the blood test was done, but the last dose of prednisone I had was 4 days before the test. Would that affect the result?
My dad is doing some paint job in the apartment but he is using water based paint. I really don’t know if that contributes to my symptoms. I’ve had worst chest infection before where I was brought to ER and my flare up usually goes within 3 to 4 weeks and with the medications I’ve took I can see an improvement.
I’m tighter breathing in, I don’t have problem breathing out. I’ve been under a lot of stress due to personal problems before it all started that’s why I’m thinking that it might be the cause of it but I’m trying to avoid it now.
They haven’t done throat culture. My first pulmonologist convinced that I should be doing well by now and there’s nothing wrong with my lungs that’s why I went for a second opinion. This time the 2nd pulmonologist told me that it doesn’t sound asthma from the PFT test and chest xray. She even told me that I shouldn’t be on Symbicort but she told me to continue it for now and after a month we will see if I need to stop taking it, so she diagnosed me with acid reflux and that the asthma medications are making it worse. They are not convinced that there is something else going on.
For the night sweats, there are nights that I don’t have it there are times that I’ll have it in consecutive days. I know it is not my room temperature or the blankets because I’ve been always sleeping with the same condition. I forgot to mention that I’m taking Mucinex 2x a day for the mucus. It’s not productive but I have to clear my throat once in a while and in the morning.
I’ll try to see primary care physician if he could do throat culture and an EKG just to make sure that it is not heart related. It really worries me because the discomfort is not going away. I have to deal with it every day.
Again, thanks for your insight!
Annaflare Seeeri
Posted
Symbicort 160/4.5 is actually the 200/6. on mine it gives both amounts. The true dose after the losses of inhalation is 160/4.5. It's impossible to get 100% of the dose from an inhaler. Symbicort is relatively harmless to take in larger quantites. My specialist had me on 12 puffs of 400/12 for a couple months bringing me back under control. Don't be too scared about 2 doses three times daily, if that's what you need.
In Vocal Cord Dysfunction... breathing in is more difficult, in Asthma breathing out is more difficult. If you're finding it more difficult to breath in, it's very likely that your symptoms are being compounded by the tightening of muscles in around your throat and larynx. And that is something that can be brought on by stress. Not saying you don't have asthma, but this is a contributing factor well worth considering as a lot of asthmatics have VCD. The only real treatment is to try and relax and practice deep breathing exercises (a speech pathologist can help provide exercises). Here's the problem, over medication can potentially make the VCD worse.. so can reflux.
Changes in weather is a fairly common trigger, especially the cold. Other triggers will show up during allergy testing. It's quite possible that the paint, even though it's water based could be contributing.. its more about how you react to the fumes given off. Like the way some cleaning products might trigger you, where as other won't.
Have you ever had a Asthma challenge test, breathing in the vapours from a hypersaline solution ith in between spirometry tests. This is a common test for asthma. I wouldn't listen to anyone about stopping breathing meds without them going through the steps to determine where your asthma stands. From the sounds of it you have a mild asthma, the hypersaline should trigger a drop (it's not 100% accurate but it's pretty close). They look for a 10% decrease in lung function, that's classified as clinically significant at a 15 - 17% drop they will stop the testing entirely.
Prednisolone and Prednisone (both are basically the exact same thing). Prednisolone is biologically active from the get go and is nicer to the liver. Prednisone (inactive) gets converted by the liver to Prednisolone (active). It depends on a lot of factors as to the effect on a blood allergy screen, it can take up to around a month, for the hormonal changes caused by it to go back to normal.
Prednisolone is an anti inflammatory (it's also the synthetic version of cortisol), that's why it can screw up the test results, it also suppresses the immune system.. immune response causes inflamation. I couldnt have blood allergy testing done, because I'd been at 7.5 mg of pred a day by the time they were thinking about it. I had to wait until i was less then 5mg a day. for at least a month. I was coming of a prolonged taper.
If you have mild asthma it could easily be asymptomatic when it's not triggered, the PFT response may seem normal. there is a distinct curve as you exhale and that curve defines asthma characteristics. This is why you should push for an Asthma challange test. You won't have been able to have any of your meds for at least 12 hours beforehand... preferably a full 24hrs for the Symbicort (in the interests of trying to get your lungs as twitchy as possible).
The night sweats can be caused by the prednisolone, it has an unfortunate side effect of screwing around with all the other hormones, in your case estrogen... it can also affect thyroid, adrenal function, insulin.. and many others. As I said earlier it can take a good month for the body to get back in balance after stopping. The higher the dose, the worse it is. If you have a really forward thinking Doctor (most aren't), some of the negatives of the prednisolone can be negated with a low dose of DHEA.
Honestly, I would start by requesting a throat culture and by requesting having an Asthma challenge test performed. I'm going to say that a fungal infection is unlikely, though asthmatics are predisosed towards them. Also, you should be monitoring your peakflows and charting them.. Morning and evening.
I didn't say it before, yes reflux often causes a burning sensation... but not in everyone. Prednisolone can also cause an increase in acid production. Yes, some Asthma medications can cause reflux. Sinus issues can cause a worsening of asthma as well.
lungs70111 Seeeri
Posted