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Cough variant asthma questions

Hi all! I was diagnosed with cough variant asthma a year ago by a pulmonologist. My worst time of year is in the winter, so I know cold has to be one of my triggers. Should I also see an allergist and a gi dr to rule out other triggers as well? I'm having a tough time this winter to the point where my lungs hurt from coughing. I use two maintenance inhalers and a rescue inhaler. TIA

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  • K8sMom2002

    Hi, Linda, and … I'll see if I can't flag down another member with cough-variant asthma to offer her perspective. 

    Identifying triggers is a key to helping prevent asthma attacks.

    Do you suspect something allergy or GI related?

    Have you tried keeping a trigger diary? Over time patterns can reveal themselves, and they can help you and your doctors figure out what's going on. 

    Did your pulmo or pharmacist give you a spacer to use with your inhalers? That can help tremendously in getting meds down into the lungs. 

    Also @Gloria and @Kathy P have both had success with a particular cough medicine…for the life of me, I can't recall the name. 

  • Gloria

    Hi Linda. Welcome to the group!

    I, too was diagnosed with asthma one year ago after a bout with bronchitis. I have no allergies, but my triggers are perfume, cigarette smoke and dust. I only wheeze when I get a huge perfume assault or several triggers in one day. Mostly I cough incessantly. 

    I was given Benzonatate a few months ago, and it has made a huge difference for me. I also use Advair, RX Flonase and Montelukast. I have a rescue inhaler with a spacer and a Nebulizer. But the two things that really make me feel that my asthma is under control are the spacer and the Benzonate! 

    My doctor told me that for some people Benzonatate is "like a magic wand", but for others it does not really help.  It doesn't have a lot of side effects or contraindications. You might want to ask you doctor about it.

  • LindaD
    K8sMom2002 posted:

    Hi, Linda, and … I'll see if I can't flag down another member with cough-variant asthma to offer her perspective. 

    Identifying triggers is a key to helping prevent asthma attacks.

    Do you suspect something allergy or GI related?

    Have you tried keeping a trigger diary? Over time patterns can reveal themselves, and they can help you and your doctors figure out what's going on. 

    Did your pulmo or pharmacist give you a spacer to use with your inhalers? That can help tremendously in getting meds down into the lungs. 

    Also @Gloria and @Kathy P have both had success with a particular cough medicine…for the life of me, I can't recall the name. 

    Thanks! I do have a spacer for my ProAire rescue inhaler, but my Symbicort apparently isn't supposed to be used with a spacer, and I'm just starting with an additional med, Tudorza Pressair, which I don't know if it can be used with a spacer.

  • Kathy P

    Hi Linda….I do manage cough variant asthma too. It can be tricky because you have to realize that coughing is an early warning sign.Good point on the spaces. There are some meds like the DPIs (dry powder inhaler) that you do not use a spacer for. My kids use Symbicort and I know they have not used a spacer. My understanding is that that med was not approved for use with a spacer. But it's always important to use your meds according to your doctor's instructions. And if that differs from the medication dispensing information, clarify with the doctor.The cough med that Cynthia was referring to is Tessalon Pearls. I used the generic. For myself, not every cough needs to be or should be suppressed. For me, the difference is productive vs dry/irritating. I have clear guidance from my doc on when to suppress a cough. Before using any cough suppressant, even an OTC like Robitussin, be sure to discuss with your doc. It may be that some other factors need to addressed in your treatment plan.

  • K8sMom2002

    Linda, has your coughing eased off any? I know some of our members swear by masks – @GigiGibson has had excellent luck with them. The air you breathe in would be warmed and might be less of a trigger. 

  • LindaD

    It hasn't eased, but I don't know if masks are the answer. The problem is I seem to be getting a lot more phlegm in my lungs. I made an appointment with an allergist to see if he can find out what is triggering this.

  • K8sMom2002

    I think it's a great question to ask your doctor. Mucus is a bug-a-bear for a lot of us. @GigiGibson actually posted another thread about a device called  that is used by folks with other lung disorders to help loosen mucus. And I know others here have talked to their doctors about medications to thin and loosen their mucus.

  • LindaD

    Thank you for the information! I am learning more about my asthma from this community than I have from my dr., who just changes meds. I didn't know that the mucous was common in cva until now. All one usually is told is about the "dry cough". I will look into Acapella and benzonatate.

  • GigiGibson

    I had a bad bout with mucus when our temps were in the 20's-30's day and night. Can't say it was the cold because I masked up. I wonder if it's the dry air of indoor heat & no humidity?  Regardless, I went on guaifenesin  400mg q 4-6 hours and after about four -5 days it was gone. It worked for me. Of course I got my docs blessing on it. I know this flies in the face of conventional medicine but I ditched my spacers and do purposeful diaphragm engaged inhalations with my qvar and symbicort and I'm doing better. Could be coincidence.  I use biotene mouth rinse at night since my meds make my mouth/throat dry which doesn't help sleep. I neb before bed and take my inhalers. Before I nebbed  three times a day I would always hit my proair before bed, kept the coughing away most of the time. I think of it as pre-treatment like I would for exercise. I think I had cough variant asthma two years before my full blown everything asthma set in, lol. It was so annoying. I only get it a few nights a month now. Before I was on meds it was all night. I'd drink two bottles of water over night. Slept practically sitting up and sprayed my throat to try to numb it thinking it was a tickle. Lol. Never knew it was asthma. I was the frog in the pot and the water was getting hotter and i didn't realize it. 

  • LindaD
    GigiGibson posted:

    I had a bad bout with mucus when our temps were in the 20's-30's day and night. Can't say it was the cold because I masked up. I wonder if it's the dry air of indoor heat & no humidity?  Regardless, I went on guaifenesin  400mg q 4-6 hours and after about four -5 days it was gone. It worked for me. Of course I got my docs blessing on it. I know this flies in the face of conventional medicine but I ditched my spacers and do purposeful diaphragm engaged inhalations with my qvar and symbicort and I'm doing better. Could be coincidence.  I use biotene mouth rinse at night since my meds make my mouth/throat dry which doesn't help sleep. I neb before bed and take my inhalers. Before I nebbed  three times a day I would always hit my proair before bed, kept the coughing away most of the time. I think of it as pre-treatment like I would for exercise. I think I had cough variant asthma two years before my full blown everything asthma set in, lol. It was so annoying. I only get it a few nights a month now. Before I was on meds it was all night. I'd drink two bottles of water over night. Slept practically sitting up and sprayed my throat to try to numb it thinking it was a tickle. Lol. Never knew it was asthma. I was the frog in the pot and the water was getting hotter and i didn't realize it. 

     

  • LindaD

    I was diagnosed last Jan. after months of that infamous dry cough. Thought I had a pulmonary embolism, because I had a history of that, and was very surprised that, no, this was a new adventure! : / 

    My mucousy coughs now are happening during a period of weather where temps are in the upper 40s-upper 50s. NJ in January shouldn't be like that!: ) So I don't know if temps are causing it. Maybe mold is growing outside?

  • GigiGibson

    I feel like it's just the progression of asthma for me. I do have it after attacks and times when I have to medicate 4-5 times. Inflammatory phase. I hope yours gets better!

  • K8sMom2002

    This is a crazy year weather-wise down south — we already have spring trees blooming out. Maples ought not to be blooming until the end of February, and here they are blooming now. Ditto the tulip magnolia trees and my shrubs. It's going to be a long, long, LONG spring.

    Have you had a lot of rain? Do you know if you have an allergy to mold? If so, the warmer than usual temps coupled with rain could be causing mold that could be triggering things. 

    When do you go to see your allergist?

  • LindaD

    Well, we have had a lot of dreary rainy days lately and we're supposed to have a nor'easter (rain, not snow) today into tomorrow. So, it could be a factor. I was tested by the pulmonologist (blood test) and was told I am allergic to mold, but was told allergists do a more complete test. I'll be seeing the allergist on 2/6. Never been to any allergists before.

  • K8sMom2002

    I'm glad that you're seeing an allergist! I think that may help give you some answers. Another thing is to make sure that you have no leaks or drips in your plumbing … sometimes a house can develop leaks and you wind up with mold and don't even know it. 

  • GigiGibson

    I wonder if I too have unseen source of mold. Hubby says you can buy lots at lowes. You sit out the tray for specified amount of time then mail in. I haven't done it yet. I want to do it at work too. Funny, yet horrible story… my coworker  was out one day for a plumbing issue. I asked her if things were all straight when she returned. She said a pipe in the wall has sprung a leak and they had no idea until the dining room curtains fell, the rod  bracket fell clean out of the wall. There was mold all behind it and inside the wall too. Gross!!!

  • K8sMom2002

    That had to be a yikes moment, Gigi!  It doesn't take much moisture to grow a not-so-lovely crop of mold.

    Have you seen AAFA's tips on ?

  • Jen

    Hi LindaD,

    Welcome to AAFA's asthma support community.  Do you currently take any medicine for your allergies?  I think seeing an allergist will help clarify whether or not you need to do anything to treat allergies in addition to taking asthma meds.

  • LindaD

    Hi Jen! Nothing yet. I'm hoping the allergist will be able to help. A lot of asthma inhalers have moderate to severe interactions with antihistamines, so I'd be hesitant to start without a dr's advice.

  • Gloria

    I didn't know inhalers are contraindicated with antihistamines! I will have to talk to my pharmacist about that because sometimes I use antihistamines if I experience good allergies (anaphylaxis)   

  • K8sMom2002

    LindaD, I hadn't heard about interactions between inhalers and antihistamines — my DD is on both, and her allergist has never mentioned a possible problem. Her pharmacist is really careful with her meds, too, alerting me to anything that might be flagged.

    Can you provide a link to some more info on that?

    Gloria, when you say you have allergic reactions to food, (I'm assuming good meant food), what kind of allergic reactions? I ask because if you have a food allergy, it's critical that you get an . Antihistamines alone can't stop a true where two body systems are involved — say, hives and breathing, or hives and stomach/GI issues. Only an epinephrine injection has that power.

  • Kathy P
    LindaD posted:

    My mucousy coughs now are happening during a period of weather where temps are in the upper 40s-upper 50s. NJ in January shouldn't be like that!: ) So I don't know if temps are causing it. Maybe mold is growing outside?

    That's very possible – if you have environmental allergies, things can be seasonal or year-round. For instance, dust affects me year-round, pollens during certain months and molds during the winter rainy season. I'm glad you seeing an allergist soon for more extensive testing. Here is more info on .

    I have not heard that inhalers have interactions with antihistamines – do you have an example of which inhaler(s)?

  • Gloria

    When I get a food allergy (shellfish, salt) my tongue, inside of mouth, throat swell up. If I catch it early in the procees, antihistamines stop it. This what my dr told me to do, but I didn't have asthma back when I got those instructions. I do have an epipen too, but I have never needed to use one.

  • K8sMom2002

    Gloria, I would circle back and talk with either the doctor who prescribes the epinephrine auto-injectors or your current doctor who manages your asthma. The reason is that asthma can definitely change the picture. 

    Here's an article that talks about — a second reaction that can happen hours after the first one, and which can happen if a reaction isn't properly treated with epinephrine. 

  • Gloria

    I just called my pharmacist about the possibility of contraindications for the asthma meds I use (Advair, Montelucast, Flonase) she said that interactions in adults are very rare, but if I need to use Benedryl, to just be cautious. Also, there can be interaction with asthma meds (primarily rescue inhalers) and ephinedrine, but of course, if you inject ephinedrine, you do need to get yourself to the emergency room. This would be especially important for me with extra heartbeats!

  • K8sMom2002

    Gloria, on calling your pharmacist! I would circle back and talk to your doctor about an .

    LindaD, how's the mucous and the cough today?

  • Kathy P

    I'm glad you got clarification on that Gloria.

    Linda – did the allergist give you info on how to prepare for the appointment? Do you need to stop any meds so they can do testing? Do you have your list of questions ready?

  • LindaD

    No antihistamines 24 hrs before the appointment. Basically I'm going to tell him my history, symptoms, and ask about allergy testing so if that's the problem, I can better manage my asthma. Any other suggestions as to what to bring up would be very helpful! ��

  • Jen

    Linda – I would suggest making a list of all of your questions and concerns.  Then I would prioritize what you discuss with the doctor. That way, if the appointment isn't very long, you can discuss what is most important and then maybe save your other questions to ask at a follow up appointment.

  • Gloria

    When I had allergy testing done (about six months ago) it was all done with a blood test. Very simple. They tested for dog  & cat dander, rodent  droppings, roach litter, several kinds of trees and grasses.

  • Kathy P

    I've had allergy testing done both ways – blood testing and skin testing.I know my doc has a specific "local" environmental panel that he orders. He tends to use skin testing if allergy shots are on the table. Any that are questionable or negative on the scratch testing then get done as interdermal testing. A small amount of serum is injected just under the skin. It's like a TB test if you've had that done.

  • LindaD

    The pulmonologist did a blood test last year, and it came back positive for mold. He said blood tests aren't as accurate or pick up as many things, so I think the allergist will be able to help more.

  • Gloria

    My insurance would not cover skin tests, only blood tests. My allergist had me do a blood test, then my Pulmo had me do a more comprehensive panel.

  • K8sMom2002

    LindaD, I'm curious to know what the allergist will say about the difference between blood tests and skin prick tests as far as environmental allergies. My main experience with the two types of tests are with food allergies and my DD. 

    Have you had a and a shot? My doctor has told me that both are recommended for folks with asthma. 

    I know in Georgia we're having those wild swings in temperature, and with it a spike in flu cases. are saying that the temperature shifts are a possible contributing factor in the spike of flu cases. 

    If you haven't had either, I would add that to my list of questions to ask either your pulmonologist or your allergist when you see him/her. 

  • Gloria

    Getting immunization are a very good point. I had to get preapproval for the pneumonia vax because I am not 65, but I was able to get it because of having asthma.

  • Kathy P

    I think my doc recommends 48 hrs prior to appointment – even for long acting antihistamines. I've also heard longer. And antihistamines only affect skin testing – they do not affect blood testing.

  • LindaD
    K8sMom2002 posted:

    LindaD, I'm curious to know what the allergist will say about the difference between blood tests and skin prick tests as far as environmental allergies. My main experience with the two types of tests are with food allergies and my DD. 

    Have you had a and a shot? My doctor has told me that both are recommended for folks with asthma. 

    I know in Georgia we're having those wild swings in temperature, and with it a spike in flu cases. are saying that the temperature shifts are a possible contributing factor in the spike of flu cases. 

    If you haven't had either, I would add that to my list of questions to ask either your pulmonologist or your allergist when you see him/her. 

    I had a flu shot, not a pneumonia shot. As far as the differences between tests, I'd have to ask the allergist and see what he says. What's DD?

  • Kathy P

    DD is dear daughter. It's internet shorthand. DS is dear son, DH dear husband, DW is dear wife.

  • K8sMom2002

    LindaD, sorry about my shorthand!  My fingers got tired of typing, I guess!

    Yes, DD = my dear daughter, who has both asthma and food allergies. 

    Would your insurance cover a  shot? Has your doctor recommended it? 

    And how are you feeling today?

  • LindaD

    Lol! No worries about your shorthand–I learned something new!

    My dr. didn't recommend it for me, just the flu shot, which I did get. And I am feeling much better since starting a new med, thank you!

  • K8sMom2002

    LindaD, are you still feeling new and improved?? What was the new med that your doctor started you on?

  • LindaD

    Thanks! I'm actually having a bit of a time with coughing due to the temps outside plummeting and the dry air indoors. Hanging in there!

  • K8sMom2002

    Maybe you could ask your doctor if he thinks that a humidifier would help? Sometimes it does, and sometimes it doesn't — but it might not hurt to ask and to try.