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Dr. Shah
Dr. Shah, Doctor
Category: Health
Satisfied Customers: 3898
Experience:  Years of experience in patients' management.
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Hello. In May, I had sinus issues which led to a pretty

Resolved Question:

Hello.

In May, I had sinus issues which led to a pretty bad case of bronchitis, then I had a very bad reaction to some penicillin I was given. I was diagnosed with serum sickness at that time. Needless to say, I was really sick with a 1-2-3 punch. Over time, the serum sickness resolved, the bronchitis got better, but the cough has lingered....mostly at night with clear phlegm. I'm being followed by a pulmonilogist and an allergist and ENT. I continue to have sinus issues, for which I'm taking Q-Nasal and Zertec-D. I was recently diagnosed with major allergies to dust mites, grass pollen and other pollens.
I'm still using an inhaler (Xopenex) as needed.

Though my sinus issues are being managed and are much better (not perfect but better). My challenge is the bronchitis. Ever since May when I got bronchitis, though I'm much better, I'm still using the inhaler, am up
all night coughing and coughing up phlegm. I feel fine with exception of the coughing, etc.
I have had a pulm function test which did show mild affect from the bronchitis. I have not had any follow up study since then. I do see the pulm Dr and he has said my lungs finally sound clear.

My question is this week, the coughing got really bad, tightness in chest and using inhaler and coughing up a combo of clear and sometimes yellow phlegm.
I'm very frustrated that I have not healed from the bronchitis and it's been four months of dealing with this. I'm not getting good sleep due to all the coughing at night, etc. I feel discouraged and scared that I'm not healing. My pulmonilogist feels that with my allergies, it's causing a visious cycle.

I'm frustrated and don't know what else I should be looking at to help me be healthy.
My CBC, labs, etc all look really good. I'd like to get another chest X-ray and will be asking for that. Other than that, what else should I be considering? I'd like to start working out, but right now, my chest is still tight and I'm not 100%
Why am I not getting over this?????
I don't smoke, I have never smoked, I don't drink, I eat healthy, I take vitamins, etc. I'm 44 and feel I'm too young to not be getting over this.....please advise....
Thank you so much!
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Shah replied 2 years ago.
Hello,
Welcome to JustAnswer!
Thanks for your question. Please provide me the following information so that I can address your concern appropriately.

How often you get this sinus problem? Do you have history of lungs problem or any other health issues? Are you otherwise a healthy person? Do you think all these issues are getting better gradually?
Customer: replied 2 years ago.
Historically, I tend to get 1-2 sinus infections a year.
I have had bronchitis before, about 3 times over a 12 year time period.
Recently diagnosed with allergy issues.
Had Two CT scans of sinuses one in April and one in May. It showed a 3cm cyst in maxlary sinus, deviated septum and thickening mucosa. Had two ENT opinions, 2nd opinion and allergist did not feel I had infections at that time and the underlying sinus issues were allergies
Befor April of this year, I was very healthy with no issues other than intermittent sinus issues.
Past history of cysts in ovaries and fibroids in uterus, all of which were removed without incident. Breast cysts that come and go, cyclical.
Expert:  Dr. Shah replied 2 years ago.
Thank you for the information.
I am sorry to hear about your symptoms.
Based on your description, you seem to have a history of sinus problem and bronchitis repeatedly in the past. However, you recent x ray chest and pulmonary function test came out normal, which means there is no long lasting damage in your lungs. I see that you have recovered from sinus issues as well as bronchitis to a reasonable extent, but you still having nagging cough with white to yellow sputum. I just wanted to let you know that recovery from bronchitis may vary from person to person and may depend on several factors. Even though people recover from bronchitis in a short time, they tends to have cough for severe weeks, and this is quite common. Since most of the time bronchitis is caused by viral infection, antibiotics are not required. However, whenever there is a suspicion about secondary bacterial infection antibiotics can be prescribed. At this time, I suggest you to go for sputum culture and sensitivity, this will disclose the type of infection and most effective antibiotics. At the same, I think it is important to rule out other possible causes of chronic cough. Since you have the history of sinusitis and deviated nasal septum, the possibility of post nasal drip should be ruled out as it can present like that. Other causes of chronic cough would be acid reflux or asthma. I am sure your doctor might have considered all these things. In my personal opinion, you should focus on resolving the sinus issues as it can related to many problems in that area. You may like to consider all different treatment options available to sinusitis such as medication, immunotherapy, surgery. Your ENT doctor would be the best person to take care of all these things.
You can read more about it from this link:
http://www.mayoclinic.com/health/chronic-sinusitis/DS00232/DSECTION=symptoms

Please let me know if you have any specific question for me.
Customer: replied 2 years ago.

Thank you for your input. I will consult with the pulm specialist as well as the ENT and allergist. Imm therapy was suggested for the allergies, but I have been on the fence with it because there is not guarantee that it will help according to the allergist.


 


I'm afraid of antibitotics as due to the serum sickness. Right now, I'm not supposed to take Levoquin, Zpack, Vicodin, Sulfa, Augmentin.


 


What would be safe for me to take?


 


As for sinus surgery, the ENT (my second opinion) doesn't feel we've exhausted all options yet and doesn't feel the surgery would help at this point. She wants to try other options.


 


My pulm function did show minor pulm disease which the pulm Dr said was due to the bronchitis and the test did not show any signs of asthma at that time. So I believe asthma has been ruled out.


 


As for post nasal drip, I have had that all my life. It is better with the steroidal nasal spray but is still slightly there.


 


Can some people really take months to recover from Bronchitis (non smoker, otherwise healthy, etc.)? While this is the exception and not the norm, is it really possible to take 5 -6 months to recover?


 


The ENT, Allergist and Pulm all agree the allergies are aggravating things...creating a cycle. I just want to stop the cycle.

Expert:  Dr. Shah replied 2 years ago.
I can understand your frustration and ongoing difficulties, but at the same time you have to realize that you have many risk factors for all these problem. As per your description, I also feel that allergy could be a common factor that can cause all your symptoms related to sinusitis and post nasal drip. As far as bronchitis is concerned, in most cases people recover from it in a short period, just that cough tends to linger for longer several weeks. In your case, it is taking longer than expected. This is possible when the cause of bronchitis has not be treated effectively or the precipitating factor is present all the time. Considering your repeated sinus problem and post nasal drip, I think this might be the reason for your ongoing issues. Moreover,d you have deviated nasal septum, that puts you at risk of sinus infection. I think if you could come out of sinus problem, your bronchitis problem may resolve. Yes, you doctor is right, immunotherapy is not 100%, and it takes time several weeks to months to achieve significant improvement, but this is one of the non-invasive option and you must keep on trying. No doubt, surgery is the last option, but can be considered if nothing works, they will also fix your deviated septum to make sure that it is not contributing further. I know it is difficult for you, but you must keep on trying all these non-invasive option before you go for surgery because surgery also does not guarantee 100% recovery. I think you are on a right tract and getting all these specialized care.
Customer: replied 2 years ago.

I saw the allergist this afternoon. He did a pulm study and said I have asthma, possible related to the allergies. He went over the results of my IGE (?sp) tests which were within normal limits. He gave me an albuterol breathing treatment and prescribed Dulera along with the Xopenex that I am taking. I'm to take the Xopenex as a rescue inhaler. He really wanted to get me on the allergy shots, which at this point, I agreed to. So I had my first allergy shots today. His thoughts are that the allergies are driving things and the sinuses (septum, cyst, etc. ) are not helping things. He said that we really need to get the allergies under control and we just may find that the rest will fall into place. He does want to do some further studies to make sure my immune system is ok but wants to wait two weeks to make sure I'm doing better asthma wise.

I must say, the news is dissapointing, but I do feel like he's very much trying to figure out which came first, allergies driving this or immune system issues. He assured me he has lots of patients in this crazy cycle and that I'm not the first he's seen.

Does all of this sound right in your opinion?

I will follow up with my pulm Dr. next week as he was closed today and I will also follow up with ENT as well....got to make sure everyone is on the same page, etc.

What are your thoughts from my visit to the allergist today?

Customer: replied 2 years ago.

I saw the allergist this afternoon. He did a pulm study and said I have asthma, possible related to the allergies. He went over the results of my IGE (?sp) tests which were within normal limits. He gave me an albuterol breathing treatment and prescribed Dulera along with the Xopenex that I am taking. I'm to take the Xopenex as a rescue inhaler. He really wanted to get me on the allergy shots, which at this point, I agreed to. So I had my first allergy shots today. His thoughts are that the allergies are driving things and the sinuses (septum, cyst, etc. ) are not helping things. He said that we really need to get the allergies under control and we just may find that the rest will fall into place. He does want to do some further studies to make sure my immune system is ok but wants to wait two weeks to make sure I'm doing better asthma wise.


I must say, the news is dissapointing, but I do feel like he's very much trying to figure out which came first, allergies driving this or immune system issues. He assured me he has lots of patients in this crazy cycle and that I'm not the first he's seen.


Does all of this sound right in your opinion?


I will follow up with my pulm Dr. next week as he was closed today and I will also follow up with ENT as well....got to make sure everyone is on the same page, etc.


What are your thoughts from my visit to the allergist today?

Expert:  Dr. Shah replied 2 years ago.
I am sorry for not getting back to you sooner.
I think you made the right choice by visiting allergist. They are specialized in allergy related problems and are capable of handling complex situation like yours. Although disappointing, but now you have one more reason for chronic cough. It might be a difficult task to differentiate which one (sinus or asthma) is playing a major role in your chronic cough. Allergy is the single most cause that can be associated with sinus problem, asthma, and chronic cough. Thus, allergy issues have to be managed appropriately. Immunotherapy is a good option, it may take several weeks and you will see gradual improvement. I also liked the idea of immunology testing as in some cases weak immunity can be a factor for repeated infection. There is no doubt, you need integrated medical care from different specialty to break this vicious cycle. I think you are making good choices by visiting all those specialist. I am sure you will be benefited in long run from all these consultation.

I hope these information are helpful to you.
Take care
Customer: replied 2 years ago.

Thank you again for your wonderful feedback. My last question is this.....IF it's discovered that my immune system is weak, is there anything I or Dr.'s can do to improve that? My IGG (IEG?) tests right now look normal, but the allergist wants to give me a vaccination and then do the test again. He states what he's looking for is a rise in a particular level which will tell him how my system responds. If the levels are lower than 70%, then it tells him I have a week immune system. He says he's been seeing a lot of this. Of course, I hope that's not the case with me, but if it is, what can I do to help my immune system.


 


I was given Dulera as an inhaler. I have not taken it as after reading on the med, I'm a bit hesitant to take it. What are your thoughts on Dulera vs other inhalers like it?


 



So sorry for all my questions....I'm just gaining clarity which will help me for the Dr. appointments that I'll have this coming week. I really appreciate your feedback.

Customer: replied 2 years ago.

My other question is does asthma cause coughing up phlegm? At night, when I do cough, I am coughing up phlegm, mostly clear but sometimes a bit yellow. So is that asthma or bronchitis at that point? Do I need to have a chest x-ray or chest CT as well to make sure all is ok and nothing more is going on?

Expert:  Dr. Shah replied 2 years ago.
Thanks for the follow-up.
It is good to know that you are being investigated appropriately to find out the reason for your symptoms. Allergy is a likely possibility in your case, but immune system may also play some role. They will tell you if that is the case. There are several factors for weak immunity such as systemic illness, medication, cancer, old age, lack of sleep, infection etc. The best treatment is to pinpoint the cause of weak immunity and treat it accordingly. At the same time, it is important to focus on the general living and life style changes such as balance diet, adequate ware, good sleep, lots of fruits and vegetables, and regular exercise that may strengthen the immune system.

As far as differentiating asthma and bronchitis is concerned, it is done by taking proper history, physical examination, and investigation. All these things are correlated with each other to make the final diagnosis. Just to address your concern, in some people asthma can also cause chronic cough along with clear or mucus phlegm.

I hope these information are helpful to you.
Dr. Shah, Doctor
Category: Health
Satisfied Customers: 3898
Experience: Years of experience in patients' management.
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