Asthma or allergy

[Super_sally888]

Good day.

I am 37 yo. 5'5", 156lb, physically fit & active female

I have had a chronic cough for at least 3 years - on and off.  No findings on chest x-ray.

Was diagnosed with Asthma end of last year after a bronchodilator test - main symptoms has only ever been coughing and feeling of tight chest / chest pain.  

Started off with symbicort which initially helped, but then coughing and chest discomfort getting worse.  

About 2 1/2 months ago I had a positive PDD test.  Chest x-ray and sputum test were all clear and they presumed past infection / latent.   Have been on INH for about 2 months already.  (I live in Manila Philippines, where TB is endemic).

When I last saw dr & complaining about continuing symptoms 2 weeks ago, I was switched to seretide 50/500 twice a day.  

I still have cough and some chest pain, though some improvement.  Cough is productive, but clear not infection type.  Cough seems to be worse after eating - so I wonder if it could be allergy or GI related.  Comes and goes during the day.  Exercise makes it worse (my triathlon team mates always joke that they know when I've hit Zone 3 Target HR because I start coughing)...  The cough is annoying but not debilitating...  

Questions:
How long should seretide take to work, if it does?  

I am worried about long term use of inhaled steroids.    PF varies between about 310 (if I miss a dose) to around 400. Is this improvement enough to warrant continued use.  

I have never had a 'classic' asthma attach - how concerned should I be about the cough as asthma symptom?  My dr. seems more worried than me.

Could the cough be due to allergy rather than purely asthma. Something else...

Is there any other approach on management?

Sally

[Super_sally888]

Thank you very much for your response.  Much appreciated.  Will persist with the meds on assumption of asthma/allergy combined.

Allergy shots not routinely available in Philippines.

Have just got test results back and found to have high serum ionized calcium along with excess bone loss.  High vit. D levels were detected in previous testing about 2 months ago. They will be testing for hyperparathyroid problem & to rule out sarcoidosis.

Thank you again.

S

[National Jewish Health]

What you describe is consistent with the diagnosis of cough variant asthma.  Seretide is the international name for the long-acting inhaled bronchodilator/inhaled steroid combination Flovent/salmeterol.  It is similar to Advair.  It should take a couple days before you get maximum benefit.

The persistence of symptoms, be they cough, chest tightness or wheeze, is the major determinant of the need for Seretide or similar medicines.  Borderline peak flows, in the absence of symptoms, is a softer indication.  The preceding is based on you truly having asthma.  It may be necessary to have a methacholine challenge.  However it might suffice to have a marked bronchodilator effect, which is an improvement of at least 18% in the forced expiratory volume in the first second of exhalation.

It could be very possible that both the cough and the asthma are a response to allergens.

As for the long term hazards of continuous inhaled steroid use, some, but not all, individuals may exhibit some side effects, most often:  skin fragility, cataracts, and hypertension.

The approach to asthma control is basically 3-fold:  pharmacotherapy, with inhaled steroids being strongly indicated for people with persistent asthma; environmental control, including avoidance of allergens and irritants; and immunotherapy, commonly called allergy shots.  There is currently a greatly renewed interest in oral (sublingual) desensitization, instead of "shots".  You would do well to consult with a board certified allergist, especially if your asthma remains sub-optimally controlled with optimum medicine and good environmental control.