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.

Wow you've been thru a lot, First nice to meet you and sorry you have asthma.
I have had perfumes, air pollution, smoke, temperature type asthma, my other triggers are gerd and allergies. Have you asked about nebulizer type treatments?
Are you seeing an Asthma/Allergy Doctor or just a Primary care doctor? If you are seeing an asthma/allergy doctor you need to consider getting a new doctor.
Xopenex nebulizer treatment might help you. Also ask about the Xopenex rescue instead of the proventil/albuterol.
Saline nasal spray might help your sinuses.
Don't know what else you could try.
this is just advise as I'm not a doctor, but just trying to help.
Keep us posted and lots of well wishes to you.
Soft hugz

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* Asthma
* Allergies
* Osteoarthritis
* Spinal Stenosis
* Mild DDD
* Enlarged
Pituitary Gland
* Fibromyalgia
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Patient: "I always see spots with my eyes"
Doctor: "Didn't the new glasses help?"
Patient "Yes, now I see the spots clearer"

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Epilepsy, asthma, GERD, depression, hypothyroidism

Thanks for all the input. I've seen 2 different allergy/asthma specialists and am now seeing a one of the top pulmonary/critical care specialist in the area/country. Even he's stumped. I know about the Xolair shots but they're not for me. I don't have a nebulizer as I've never been so bad that the inhalers don't work. I have had short periods that i was able to drop my Advair to one dose but that was over 2 years ago.

It's not like everybody at work is a problem. (very small office environment and medium manufacturing area) I've been trying to get through to the few people that give me problems. Funny thing is one of them has a child with asthma. You'd think they'd understand better. I can't move where I work due to what I do, or avoid the problem areas entirely. I think a big part of the problem comes from the fact that I look healthy, aside from the cough.

I do have a tendency to wait a really long time before I admit defeat and go to the doctor. I just keep saying it'll be better tomorrow. One day leads to the next and then months have gone by. I probably put up with way more than I should. Something I learned from living with a torn ACL for 13 years. (I've often wondered if having knee surgery didn't start all this. It was about 6 months after that all this started.)

I don't feel like I have GERD as I don't have any of the symptoms. But it was thought that I had silent GERD as that is one of the things that can cause unexplained cough. That's why we tried the drugs to see if made any difference.

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...........

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************************
* Asthma
* Allergies
* Osteoarthritis
* Spinal Stenosis
* Mild DDD
* Enlarged
Pituitary Gland
* Fibromyalgia
*************************
Patient: "I always see spots with my eyes"
Doctor: "Didn't the new glasses help?"
Patient "Yes, now I see the spots clearer"

Could be a sulfite issue. Have you tried Vitamin B12 supplements to see if that helps reduce your cough?

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-Razzle

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.

As I read your posting all I could think is I am living your life! I have been through just about everything you have mentioned. Currently I am doing the flovent, singular, nasalnex combo. It is still not effective. My CVA only flares when I get a cold, then it lasts for 4-6 weeks. I am in the middle of those weeks now and am soooooooooo digusted. I don't sleep (currently 4:00 am), miss work (I'm a teacher), and generally am so miserable  for a good month I can barely interact with my three young children. Have you found any relief since your posting? I am willing to try anything!

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.

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~latinachic84~

Generally I am doing better than I was before I started the Asmanex, but... Just as I was feeling okay and not coughing a lot, the weather turned super cold and that sent me coughing again. Anything below 50 degrees seems to bug me. Get below freezing and I'm a mess. I am using my inhaler more but not every day. I should probably call my doctor but I don't feel that bad. (Though that is relative. I'm by no stretch of my imagination healthy.)

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,

My son (he's 16) has cough variant asthma too. He currently is on no meds because it's not bothering him at the moment but for the times that it does, he uses Singulair, Asmanex and Albuterol. Plus it helps him at night to have a humidifier in his room. His cough isn't a barking time, just a dry sounding cough and frequent. So too I give him Robitussin if it's too bothersome for him which helps but it doesn't take his cough completely away. If you feel that the cough is in your throat then it might be allergies. And your throat is being irritated by post nasal drip. I have that too so right now I am on Allegra and Singulair. I have yet to find something that takes away the PND completely but the meds help a little. Have you ever tried nasal allergy meds?

Btw, welcome to Healingwell :)

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Moderator, Allergies/Asthma

Hi,

Thanks so much for your responses and the warm welcome. I appreciate hearing from other people who are going through or have been through the same thing.

I went to an internal medicine doctor today, and I had a CT scan and blood work. I go back tomorrow to see what's going on. I have been using the Advair twice a day (for about three days now) and the Albuterol as needed. Also, I started a 14 day course of Prilosec to help out if it's GERD. Still nothing's helping to rid me of the cough so far, and this time around, it's been at least 3 weeks. I am hoping for a diagnosis and treatment plan tomorrow. My throat is killing me from all this coughing, and I have throughly annoyed my family and co-workers with the hacking.

Thanks again,
Sandee

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Moderator, Allergies/Asthma

I don't usually post here, but your title caught my attention. I had an episode of post-infectious reactive airway disease starting in 2000. Like you, I coughed all the time, sometimes until I threw up. I had wheezing with a normal spirometry in the office but decreased capacity on getting up in the morning. My terrific allergist worked patiently with medications and recommended nasal lavage - washing my nose out with a bulb syringe and saline. When I finally started doing that three times each day, I started to get better.

It certainly isn't a cure-all, but I recommend it highly.

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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,

Have you been tested for fungal sinusitis? It can cause severe post nasal drainage and won't get better on any allergy medication you throw at it. Requires anti-fungal medication to treat it. I'd discuss this with a Naturopathic Physician and get another opinion from an Ear-Nose-Throat specialist.

Regular pharmacists have access to some information about herb-drug interactions; more detailed information may be found by consulting a Compounding Pharmacist or Naturopathic Pharmacist.

Good luck,

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-Razzle

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Moderator, Allergies/Asthma

I, too suffer from the type of asthma you all are talking about, it seemed to start with perfumes, they progressively over the years developed into an intolerance to ANY fragrance, smoke, animals, cold, humidity, etc. I also had to ask co-workers to not wear perfumes and relatives. My relatives finally stopped wearing perfume, but the shampoos, creams, etc. they use are all perfumed, so it hasn't helped much, and they all burn candles, use plug-in fresheners, etc. I'm also senstive to sulfites in wine(turns my face beet red and my ears burn). I've tried all the nasal sprays, all the antihistamines, albuterol, etc. The ONLY thing that helps me is decongestant, namely Sudafed...course now it's hard to get. I have to show my license at the local pharmacy, and can only buy a little at a time. I've taken to ordering it from Canada in the form of Drixoral, or Zyrtec D. I need the antihistamine as well. The new decongestant over the counter called Phenlephrine works some, but not as good. Of course every doc I see says I shouldn't be on decongestant long term, but I've tried so many times to not take it, even went 9 months without it when I was pregnant just using nasal sprays, I was so miserable, and suffered from awful PND that makes me so sick to my stomach...so I've decided to not suffer anymore, and take the decongestant. I take 12 hour drixoral every day, and 12 hour zyrtec D during pollen season in the morning. Sometimes at night I take a four hour over the conter decongestant(phenylephrine) to get through the evening. Decongestants before bed keep me up at night, though. My Mother has suffered from the same ailments as me and takes zyrtec D 12 hour daily, and supplements with a nasal steroid spray at night. I'm sorry to see so many others suffering from the same ailments as me, it's so frustrating when other people don't understand. Unfortunately, I now have a 5yr old suffering cough variant asthma, so my family has seen him miserable, and now they belive me.
He takes zyrtec(antihistamine) syrup nightly and flovent 110 one puff a day. He is too young for the decongestants they tell me, so I try to limit his exposure to triggers whenever I can.
Debbie

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Moderator, Allergies/Asthma

WOW!

I am new to this site and forums and I am not feeling so alone anymore. I developed asthma at around 20 and I am now 33. I am on Advair (inhaler not the diskus) 125, 2 puffs twice daily, Salbutamol 2 puffs, 4 times daily, and Nasonex (Coticosteroid) nasal spray. My main and constant symptom is coughing as well as the annoying wheezing. So bad in fact that my husband sleeps in a seperate room. I find that sleeping on my back with more than one pillow under my head seems to help as well as washing all bedding in hot water a couple of times a week and keeping on top of the dust situation all around my bed. I was almost living on cough syrup. I find it exhausting, the sore throat, the constant coughing, the trouble sleeping cause of the cough at night. I never realized there were so many other people with the same thing. I am super sensitive to cigarette smoke, wood fire smoke, strong scents of any kind, dust, and changes in temperature and weather (humidity). It seems impossible to control the cough 100% but the Nasonex makes a noticable difference. Only drawback is the bleeding nose, and changes in ability to taste food. My doctor said that my GERD was definatly making things worse. She says that it can actually scar your lungs a bit, so I take Prevacid 30mg twice a day for the GERD. I wish luck to everyone dealing with this. It's nice to have somewhere to talk about it.

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Moderator, Allergies/Asthma

Thanks for being so welcoming. I am so happy to have found this site. You are all so kind and helpful. I have seen an allergist, and a GI.I specialist. I had a gastroscopy done and I definatley have GERD. The doc had said something about surgery if it gets really bad but I was kind of scared to go through it unless I really have to. I know what you mean though, the constant coughing is just draining, makes your whole chest cavity hurt and makes my voice sound rough. Not being able to sleep in the same room as my husband sucks, but he has Multiple Sclerosis and has his own difficulties with sleep and I sleep elsewhere because I really want to keep him as rested as possible. Howerever I am at the point that I am looking into the surgery because I am really tired. THe coughing seems to be worse at night. I am in Northern Ontario, Canada and the cold winter were having is also not helping. Once again thank you for being so kind and welcoming!

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,

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-Razzle