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Changing Asthma or Something Else?

I have had asthma and severe allergies my entire life. I am now 32 years old. I have noticed a significant change in the symptoms I am experiencing.  I had a long exacerbation in the middle of January through the end of February including er visits, 30+ days of prednisone, and exhaustion. My symptoms are typically wheezing, shortness of breath, tiredness, and decreased peak flow.  I do not typically have a productive cough. This exacerbation could not be traced to allergies or infection/virus as is typically the case. When I have no symptoms, my oxygen saturation is 99 and falls to 96 or 97 when sick.

I was relatively symptom-free for a month.  Since the middle of April, I awake to a productive cough and a wheezy cough. Nasal allergies are well controlled.  The cough very quickly turns into what I can best describe as a coughing fit taking several minutes to get under control.  The cough is wheezy and sounds productive. The cough is present 24 hours a day if I take a deep breathe then exhale (coughing or wheezing happens on exhale). In the course of a day, I cough up approximately a quarter teaspoon of sputum. I do not have a fever, oxygen saturation has been 96-97. I am concerned about the change in symptoms and the length of time I have had symptoms yet it's not bad enough to go the ER and the earliest I can be seen by my doctor is the middle of June).  

I currently take albuterol (nebulizer or inhaled as needed), qvar, zyrtec, singulair, flonase to treat asthma and allergies.

I would like a suggestion as to how to respond to these new symptoms and if I should worry about the change in these systems.  I am worried that I am either experiencing the beginning of remodeling or an untreated infection (no symptoms besides the sputum and don't belong to any high risk group that would lead to chronic infection).  I am allergic to molds and am slightly worried about the possibility that this could be something like ABPA.

Thanks in advance for your help.

1 Responses
242587 tn?1355424110
MEDICAL PROFESSIONAL
Your concern about this persistent worsening of your asthma is understandable and justifiable.  Everything you describe is consistent with asthma worsening but this could be ABPA.  There are specific criteria for the diagnosis of ABPA and it would be reasonable for you to request that your lung specialist reevaluate your present condition with that diagnosis in mind.  Other possibilities would include more intense exposure to allergens or irritants, either at home or work and others such as, uncontrolled allergic rhinitis/sinusitis or the development of gastroesphageal reflux (acid reflux).  You and your doctor should systematically consider all such causes that might be the cause of the recent drastic change in asthma control.

You mention Q-var as one of your medications.  Inhaled steroids can be very effective in the long-term management/control of asthma but, in your current circumstance, it might be helpful to switch to a more potent inhaled steroid or the addition of an oral steroid (prednisone)to your regimen.  I mention these as potential approaches, not as recommendations.  At the same time I would deem it appropriate for you to be in contact with your doctor by phone or E-mail and for you to request that you be seen for reevaluation, prior to the middle of June.

Good luck
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