Chronic Sinusitis and Asthma

Saturday, July 25, 2009, 11:22
Asthma
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Asthma and chronic sinus disease

Erin:

I have a sneaking suspicion that I have asthma, but my doctor hasn’t seemed too willing to talk about that as a possibility. I have allergic rhinitis. I get this strange sickness about once every six weeks that starts as a sinus infection, and then falls into my chest, leaving me with a terrible, creepy, unnatural voice and very shallow breathing. I feel like someone is sitting on my chest. My doctor just keeps on prescribing antibiotics and then the sickness goes away, but always comes back again six weeks later. In between times I have a lot of postnasal drip. I’m currently taking Zyrtec and using a Rhinocort inhaler. Please help me, I’m tired of being sick, sounding terrible and using antibiotics. And if I do have asthma, at least could I get a jump-start on this crud in my chest?

Dr. Shapiro:

Really! Gee, that’s terrible. It sounds like Erin has two situations. One is probably asthma, and it may be asthma that’s only triggered during these times of an infection. Erin might benefit from a peak-flow meter, because then she could find out if there is a drop that would be an objectively measured thing, so she could talk to the doctor and say, listen, I’m usually like this and now I’m down 50 percent, there’s no doubt about it. The other issue is whether she has chronic sinus disease and is getting recurrent infections that then trigger the asthma. And there’s an interesting connection that we don’t totally understand between sinusitis and asthma. It’s not unusual. It’s sort of like the reflux connection, except it’s up instead of down–running from the head instead of the stomach. It sounds like she develops a cold or possibly a sinus infection right away. A cold might go into a sinus infection, or she might just be having sinus disease and then that triggers the breathing problem. The postnasal drip and drainage that she describes goes along with sinus disease. So she needs to be evaluated for asthma, and the peak-flow meter would be helpful. And she might need to have an examination along with some special imaging studies–X-rays of the sinuses or CT scans of the sinuses, to see what’s going on there.

Andrew:

I have a question, too, related to Erin. If somebody does have that sort of chronic sinus infection, would a very low-dose antibiotic be indicated there? I know you don’t want to over-prescribe antibiotics, but is it like an infection that never really goes away?

Dr. Shapiro:

More often, actually a high dose is needed for perhaps a longer course or maybe a better antibiotic that’s been used to try to knock out something that’s been partially treated, and then simmers along and comes back. So this might be an under-treatment of infections. Every now and then patients are put on a low dose, almost prophylactic therapy, for sinus infections. But more likely she needs to be hit with a harder, longer dose. And the sinuses need to be assessed to see if there’s some structural problem that causes these things to keep coming back.

Andrew:

I understand sometimes surgery is even indicated.

Dr. Shapiro:

Sometimes, yes. Erin, the Zyrtec and Rhinocort are good medications for allergic problems in the nose and sinuses, and they are often used to try to decrease sinus troubles. But it just doesn’t sound like they’re doing enough for you.

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