Respiratory Disorders Expert Forum
Recurrent Bronchitis
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Recurrent Bronchitis

Hi,

I have been experiencing recurrent bronchitis-like symptoms for the past 3 months and have had great difficulty resolving these symptoms. The history/pattern is as follows:

In early November I had a sudden onset of a severe, dry cough followed in a day or two by malaise, runny nose, fatigue without much of a fever.  Unlike other colds I've had, the primary feature of this illness was severe cough, which was initially dry and unproductive but later yielded white mucous. This initial episode resolved in about 7 days without any medication besides use of a bronchodilator (I have exercise induced asthma).  I had received the H1N1 vaccine 5 days previous to the onset of the cough (I work in a hospital setting).  

I resumed exercising and 3 days later and the severe cough came back and I developed a high fever and extreme malaise.  Breathing was difficult and noisy and coughing was productive with lots of white and yellow mucous.  IMy family doctor prescibed Biaxin for 10 days.  Began to felt better but then caught a cold from my infant daughter.  Again, after about 10 days I felt better and began to exercise again but noticed that my lungs remained very reactive - to cold air, in particular.  

In mid December (about 2.5 weeks later) the cough returned as did the malaise, mucous and reactivity - prednisone (25mg for 5 days) and Clavulin (10 days) were prescribed.  These symptoms abated quickly but the lung reactivity was still present.  I rested for two weeks and just recently started hockey again - reactivity was still there and now the malaise and coughing have returned (although less severe).

I'm wondering if there is an underlying inflammation caused by the initial infection that is not resolving and allowing bacteria (or something) to continue populating my lungs or maybe even GERD?. Any thoughts re: diagnosis/treatment would be appreciated.  I am a 33 year old non-smoking male who exercises regularly.      





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The most likely explanation is that the November infection (assuming that it was infection) did lead to increased inflammation and, with it, bronchial hyperreactivity, one manifestation of which is your increased sensitivity to cold air.  The subsequent symptoms could then be primarily on the basis of asthma, rather than recurrent infection.  The temporal sequence of events would be much more consistent with acute infection that with the diagnosis of GERD.  Unless there is currently definite or highly suggestive evidence of infection, increasing the pharmacologic therapy of your asthma would probably be the best approach.

One can only speculate on the nature of the presumed infection.  For all we know, the November episode could have been a Mycoplasma infection (with the seeming response to Biaxin), but that would ordinarily not respond to Clavulin. Some forms of asthma, associated with Mycoplasma also respond to Macrolide drugs such as Biaxin.  Or is could have been pertussis (whooping cough), the symptoms (especially cough) of which can linger for months.

That there are no infiltrates, consolidation or effusion is good news.  The description of moderate hyperinflation and a low diaphragm is consistent with air trapping and, hence, with the diagnosis of sub-optimally controlled asthma.  All the more reason to work with your doctor to achieve optimum control of the asthma.

However, there is another, uncommon lung condition that can follow a viral infection, inhalation of an irritant, or be associated with what is called Connective Tissue Disease.  This disease  called Bronchiolitis and occurs in several forms.  X-ray infiltrates (shadows) are often seen on a chest X-ray, but not always.  Sometimes the only initial finding is hyperinflation.

My advice is that you and your doctor first determine if the problem is a worsening of asthma and observe if it quickly responds to vigorous asthma therapy. Before and after (therapy) pulmonary function tests should be performed. If there is then, any reason to suspect that asthma is not the problem, I strongly suggest that you and your doctor request consultation with a lung specialist (pulmonologist) to determine if you are suffering from bronchiolitis or some other non-asthmatic disease.

Good luck
3 Comments
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Avatar_m_tn
As a follow-up, my last lung x-ray (taken in early Jan) says:

Lungs show moderate hyperinflation and low diaphram.  No acute infiltrate, consolidation, CHF, or effusion is seen.
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Avatar_m_tn
I feel compelled to account my problems with postnasal drip and all accompanying symptoms, misery, and now finally, a complete cure.  It is a long story, similar to the many I have read about on numerous websites, sans the cure part.  

It started about 10 years ago or so with an occasional itchy throat and occasional cough, sneeze, or throat clearing.  It continued to evolve through the years to get worse and worse, so that eventually it was debilitating, i.e., there was no normal life left.  In the past three years, my business took me to China on some dozen occasions and while the stress of the trip is always pretty bad regardless of how you try to mitigate it, my trips were particularly stressful since I would return home with very bad sinus symptoms and be insomniac for up to a week afterward; more than could be accounted for by jet lag alone.  In fact, eventually in the last couple of years, the symptoms were just plainly bad without regard for the trip to China.  

I couldn’t breathe and I couldn’t sleep.  I was wheezing like I was asthmatic and was frequently sick with a cold or the flu.  The insomnia could only be relieved with a strong dose of diphenylhydramine and Advil.  I couldn’t lay on my left side for the wheezing and coughing.  I had frequent headaches and rare migraine with aching muscles and joints.  I developed a cardiac arrhythmia that lasted for several months before more or less magically disappearing.  I know now why.  I had to make a trip during all of this to a near sea level location, and since I live at an elevation of almost 6,000 ft, I was unable to clear my Eustachian tubes and lost my hearing for some time.  I now wear hearing aids with a permanent hearing loss that was partly, at least, due to that event.  In general, I have been a miserable human being and increasing felt unable to function.

I tried every known remedy.  I spent thousands of dollars in pursuit of relief.  I tried antibiotics, anti-fungals, antihistamines, immune builders, vitamins, nose sprays, oregano oil, you name it, I tried it.  No relief.  I changed my diet to exclude gluten, milk, and sugar, and unless you have tried that, you can’t imagine how little there is left to eat.  None of it gave me lasting relief.  And then one day. . .

I splurged and ate a little Bryers ice cream one evening.  I had already concluded that sugar and milk were having little impact on the symptoms, but I got increasing worse as the evening wore on.  I looked at the ingredient list and saw that it had little in it but milk, sugar, and carrageenan.  So I wondered what is carrageenan?  I looked it up and discovered that it was a thickening agent made from seaweed, and that it could contain up to 20% MSG???  So I wondered, is that the key problem with it??

This began a quest to uncover just what MSG, the substance we have all tried to avoid for years by reading labels, was really about.  Our discovery was profound!  MSG is now contained in as much as 90% of all commercially available food items.  It is in just about every mouth full of food we eat in this country.  I ate a pretty pure diet, but it didn’t matter.  I checked the symptoms of MSG sensitivity and poisoning, and there I was!

My wife and I (she also has symptoms of sensitivity) immediately threw out a 6 months supply of extra food (several thousand dollars worth) and we are now on a MSG free diet.  

My symptoms of MSG poisoning, every last one of them, along with my wife’s, disappeared in less than 24 hours!!!!!

I no longer have any of the problems that have plagued me for a long portion of my life.  I strongly suggest that anyone with this problem do a simple two or three day test to see if it doesn’t stop their problems as well.  It is not an easy transition to make and live with, but a hell of a lot easier than the continual life-robbing suffering.  

I am including a list of links that can be opened to better explain how this situation is so out of control in the US and abroad.  China is a hot-bed of MSG and undoubtedly contributed to my final three years of increasing misery.  PLEASE, for the sake of yourself and your family, read the list of ingredients that now secretly hide the fact that MSG is in everything you consume.

I well know I sound like a radical zealot who has an axe to grind.  I am not, but I never intend to allow the FDA, food companies, medical profession, health supplement companies and US government to destroy my health and life again.  Please take action for yourself.  I am a Pathologist (research and industrial) by education with a strong background in biochemistry and I know what I am talking about.  Please open the links below.  

http://agentlejoy.wordpress.com/2008/05/01/msg-hidden-and-not-so-hidden
http://www.truthinlabeling.org/ (a huge website)  
http://www.msgmyth.com/  (a book written by someone who found out like I did)
http://www.msgtruth.org/avoid.htm
http://poisonevercure.150m.com/monosodium_glutamate.htm

This is just a few of the hundreds of sites about this terrible problem.  

Skip Halterman
Navajo Dam, NM  


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