have ben on antibiotics for lngs constantly

[mibli]

could you enlighten me what could be major source of problem still need diagnosis, Shortn breaths
have had recurrent chest infections with constant dull pain in upper back under sholder blade for months  and sharp stabbing pains lower down . I have a wheeze for a long time more noticeible on exhalation as well as crackle when i have infection My acid reflux has also worsened i have burning stomache have saliva in throat and regugitation.  have reflux coming up to throat and then vomitingi Also have been unwell urine infection from febuary lots of different antibiotics still have it on long term trimothropine  i have to sleep propped up due to painful lungs and choking on saliva and difficlty swallowing saliva and i sometime choke on food  .It started last september09 and has now got worse since jan10 this yr . altough have had previous what was called a big lung infection 4yrs ago which initially has started this roller costerof respritory problems   numerous antibiotics to treat also presidone in which only temporarly helps then all symptoms return . Spiromotey test at gp each test had loewr peak plow 350 -i think 275. Went to a&e march 10with kidney pain also had endoscoppy for abdo pain diagnose h pylori peviuosly been treated 4 times anti b prior was told never radicated got antibiotics and await follow-p b test aalso  awaiting e n t for throat had lft at resp clinic have appointment for histamine test and in not clear result said may get ct scan what do you think

[David Tinkelman, M.D.]

Recurrent respiratory infections, concurrent with recurrent urinary tract infections is a very common scenario because infection in each of these sites, lungs and urinary tract, is very common.  For this reason, the occurrence of these two, together, does not mean that they are related in any way, including having a common cause.  Were there a common cause, it would be a problem with your immune system but, unless you have also been prone to have infection elsewhere in your body, that is unlikely.

It is especially unlikely since there are at least two (maybe three) other reasons why you might have recurrent respiratory infection:  1) having once had a “big lung infection”, your lungs or even a part of one lung may have been permanently damaged, with the damaged lung less able to resist infection; 2) the dreadful reflux and regurgitation that could well be associated with recurrent aspiration of material from your stomach into your lungs.  When this happens, the result can be chemical pneumonia and/or infectious pneumonia and, 3) that recurrent lung infection could occur as a result of acquired, non-infectious (even allergic) lung disease or an inherited (congenital) lung disease, for example Cystic Fibrosis.  Yet another possibility is that you have had the misfortune to acquire a rather uncommon type of infectious lung disease, one not completely responsive to most conventional antibiotics.

Let’s just assume that the urinary tract infection, while a serious, debilitating problem, is unrelated.  You should seek consultation with a Urologist or a Nephrologist to determine with certainty the organism(s) causing recurrent infection and determine if you might have any anatomical abnormalities in your urinary tract that could predispose you to infection.

As to the respiratory infection, there is a strong possibility that it is related to the gastroesophageal reflux (GERD).  You mentioned having had endoscopy and being treated for H. Pylori.  I assume that there was evidence on endoscopy of severe reflux.  Did the GI specialist also address the GERD, with pharmacotherapy.  You should be treated for an extended period of time with optimum reflux therapy.  If that fails to control the reflux, you may be a candidate for surgery.  If either were effective, you might experience the resolution and non-recurrence of your lung problems.

In the meantime, however you should also ask the  lung specialist (Pulmonologist)  in the respiratory to determine if you have any other lung disease that has developed independently of reflux induced lung disease. One you specifically might ask about is mycobacterial infection; specifically MAC disease, with or without bronchiectasis.  Obtaining the CT scan of your lungs should be a priority, as it could well establish a diagnosis with reasonable certainty.  The histamine challenge does not strike me as a priority, at this time..

You should ask that one of your physicians assume the role of coordinator of your care.  The person who will bear responsibility for synthesizing all the available data and making the final recommendations to alleviate your problems.  

Good luck

[mibli]

hello Dr David,  I've had challenge test and physiologist did not see any findings to suggest asthma . I had to go for emergency appointment this week as pain in back of chest more so sharp stabbing pains legs at back of calfs heavy feet tingling GP sounded chest said it was my bronchitis with an asthmatic type wheeze and high pulse put on more antibiotics and pridisidone . i am home feeling ill with stabbing pains not offered to go for chest x ray what would you suggest now have to wait 6 weeks till next appiontment with hosp resp doctor

[mibli]

Dear Dr David I thankyou for your response to my med issues i am greatful . I would also add i feel i have someone who can give me some understanding as my gp systems is very slow and gp does not take time to go into diagnoses ,tests anddiscuss their veiws on   what  my trobles are related to .Iforgot to add i am a female 54yrs old non-smoker work in a smoke environment iam working in homes cigarrette filled  little or no ventilation most of the time as clients refuse to open windows to let out clouds of smoke to make it easier to work in. clients can be intolerent to non smokers health issues as n which i have had difficulty working (home carer) I have develped over the past 6mths or more an intolerance to smoke and cleaning agents used in home due to my chest problemshave had to change clients to non smoking clients which but there are more does than does'nt in the elder generation  . my chest tightens up in clients homes in those conditions i have tasted nicotine back of throat clothes very badly smell have to spit out when leave a clients home  p. s.i am worried how i can work long term in this environment am single parent always worked need job for morgage finances e.t c.been off sick with the above med issues and am at present on more antiobiotics and predisidone awaitng tests histamine , ent, also am b12 defficiency 3 mthly jabs can you advise course of action your comments much appreciated x