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TheGermDoctor
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Category: Medical
Satisfied Customers: 1549
Experience:  17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
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About 8 years ago I was diagnosed here in the UK with aspergillosis

Customer Question

About 8 years ago I was diagnosed here in the UK with aspergillosis which is being controlled by various doses of Itraconazole About 9 months ago I started a persistant dry cough which my GP or my consultant cannot advise on how or what to do to alleviate this problem
The constant coughing gives me bad headaches leaving me very tired and low enegy levels and although I managed to get some relief from antihistomine tablets containing loratadine, they are now making me feel sick and dizzy after a few days and I have had to stop taking them leaving me still with the problem
Can you suggest any other drug that could possibly help to relieve the coughing.
Just for information I,m having regular x-rays and blood tests and my peakflow is about
350
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 3 years ago.

DocPhil213 :

Hello. My goal is to help you find an answer!

DocPhil213 :

Do you have sinus congestion or reflux? Also, what other meds are you taking?

JACUSTOMER-f53bmvei- :

No sinus congestion

JACUSTOMER-f53bmvei- :

yes to reflux

JACUSTOMER-f53bmvei- :

Meds;- seretide 500, montelukast 10mg, Trimethoprim 100mg, Amitriptylinr 10mg

Expert:  Dr. Phil, MD replied 3 years ago.

Reflux could be the reason for the chronic cough and you aren't really on any treatment for it. Reflux is a common reason for chronic cough.

 

I would initiate treatment for the reflux and see if this helps. Give it a couple weeks to work.

 

You can get omeprazole over the counter. It is an excellent reflux med.

Expert:  TheGermDoctor replied 3 years ago.

With all due respect to the above answer- I would not take that advice.

 

I assume you are taking Itraconzaole tablets- these need to be taken with acid for optimal absorption ( cola drinks) and taking an antacid will defeat the purpose and likely make drug levels quite low.

 

Your cough is likely due to ongoing Broncho Pulmonary Aspergillosis and asthma, which I suspect you have. You should continue on the itraconazole, and the montelukast. You also should ask your doctor about adding in an inhaled steroid- this is the standard of care for ABPA. Discuss this with your doctor and pulmonary specialist, rather than taking something that may make things worse ( as advised above).

 

Good luck.

 

Always ask if you need clarification/more information.

If I have answered your question, please click the ACCEPT button so I can get credit for my work.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

Expert:  TheGermDoctor replied 3 years ago.
See my added answer posted.
Expert:  Dr. Phil, MD replied 3 years ago.

I appreciate the other expert's advice. It is always good to get a second opinion. However, it is quite obvious to me that he didn't read/understand your entire post. In your post, you clearly state that you are already on seretide. Which, if you look it up, is an inhaled steroid. So, you are already on treatment for ABPA yet you are still having cough.

 

Therefore, it is wise to look for another cause. In this case, its reflux. You should definitely talk to your doctor about acid suppression therapy. While it is true that they may interact with other drugs, that doesn't mean you can't take them. It can be adjusted easily based on time of day you take them, etc.

 

Thanks for your time and don't forget to accept when you are satisfied.

Expert:  TheGermDoctor replied 3 years ago.

The issue is likely the dose of the inhaled steroid.

Your current dose is likely too low.

Most patients with ABPA also need oral steroids as well, if inhaled is not sufficient..

 

You would be best served talking about all this with your doctor.

Again, there is little evidence your symptoms are from reflux and the recommended treatment above of omeprazole would not be advisable and may be dangerous.

 

Good luck.

 

Always ask if you need clarification/more information.

If I have answered your question, please click the ACCEPT button so I can get credit for my work.
POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

Customer: replied 3 years ago.

At present I am on a rest period from Intraconzole, its been 6 months, and the consultant is trying to leave the steroid approach in reserve so Im really looking for something new and different--have you any other suggestions?

 

PS have used omeprazole in the past but it didnt agree with me, I think that was for reflux

Expert:  TheGermDoctor replied 3 years ago.

Well, I am afraid you just can't have it both ways.

Either you choose the itraconazole and steroids, or you will have cough.

 

The fact that you are off steroids and itraconazole is even more support for my concern that this is the ABPA causing your chronic cough again.

 

Again I would strongly urge you to discuss this with your pulmonary doctor as a far better way to improve your symptoms; but without seeing you, I suspect you need to go back on antifungals and steroids. This is the best way to treat this condition.

 

Good luck.

 

Always ask if you need clarification/more information.

If I have answered your question, please click the ACCEPT button so I can get credit for my work.
POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience: 17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
TheGermDoctor and 5 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

thanks for your input,just hoping there was something else available on the market which hadn't been considered and could have been a long shot

no reply needed

Expert:  TheGermDoctor replied 3 years ago.

Good luck to you.

 

One additional thing you may want to look into is called Xolair- it is an anti-IgE antibody that helps in asthma and ABPA- and can be steroid sparing.

 

Not sure as to its availability in the UK though.

 

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