Respiratory Infections And Asthma
- Wednesday, July 15, 2009, 10:12
- Asthma
- 396 views
Pam:
I’m in my mid-40s and I have been asthma-free for as long as I can remember. I allegedly had it as a child, but I have no memories of it. About a year ago I went to see the doctor with difficulty breathing. I was very sick. I thought I had some kind of respiratory flu, and I went in and I announced to the doctor that I had either bronchitis or pneumonia. He said, “In five days if you’re not better, come back. But I think you will be because all you have is some kind of virus.” And I said, “But I want an antibiotic.” Well, I was so angry at this treatment that I stayed away about 10 days, and by then I was really, really, really sick. So I went back and I insisted on seeing my own doctor, and she said I was down to 45 percent of my lung capacity and I had asthma! And my question is, could I possibly have averted getting asthma if I had gotten an antibiotic earlier?
Dr. Shapiro:
Generally, I would say no. Typically it would start as a virus and then you might develop a bacterial problem. But the real issue was not having management of the asthma part of it, rather than the infection part of it. And one of the problems that you brought up is that the first doctor didn’t do anything to measure your lung function.And we haven’t talked about this yet, but it’s very, very important that people know that asthma should be measured. Proper care involves using either spirometry, which is a more sensitive technique, but it is also something that most primary care people don’t have. Another reason to think about a specialist besides the things we were talking about before. Or at least peak flow, which is a way to measure at least large airway function. And peak flow can be measured with very inexpensive devices that should be available in any doctor’s office. Your second doctor did use peak-flow and was able to show that you did have a big decrease in lung function. So you might have been stuck in the same situation no matter whether the doctor gave you an antibiotic or not. But having the right diagnostic tools with the peak-flow meter was what made a big difference for you.
Andrew:
Pam, how are you treated now for this? Did the breathing problem go away? Are you on any ongoing medication?
Pam:
Yes, I guess for the rest of my life I’m on Flovent and albuterol. Morning and afternoon–or evening puff. Of course, immediately after I was measured at 45 percent I had to take all kinds of antibiotics. We had to go through Augmentin and all kinds of antibiotics before we found one that knocked it out. It had gotten very bad.
Andrew:
And I’m happy to say, from what you’re saying, it sounds like your asthma is under control now. And it sounds like you know now that one of the triggers for your asthma, if I’m right Dr. Shapiro, is an upper respiratory infection–your “hot button” if you will.
Pam:
I don’t think I had asthma before, though. I mean, I was never diagnosed with it.
Andrew:
Is that something that comes up for adults in mid-life, Dr. Shapiro?
Dr. Shapiro:
Yes, certainly, many people develop asthma just as you did, with an infection. Suddenly they have chest involvement and they never had it before. We don’t really understand why. Again, it’s something about the genetics and the environment, and this is not an unusual situation.
Andrew:
But also related to an upper respiratory infection, I went through one this winter as I’m sure many of our listeners did. And for your doctor to say that it is probably viral and let’s wait about antibiotics, that’s not unusual.
Dr. Shapiro:
No, that’s good advice, actually.
Andrew:
What about knowing when to call the doctor? Maybe you could give us some advice on that, Dr. Shapiro?
Dr. Shapiro:
Yes, because the key here wasn’t the antibiotic, it was the diagnosis of asthma. If you are on medication like Flovent, as you’ve mentioned, you will hopefully see fewer difficulties in the future, and you’ll be able to get a cold, probably, without having your lung function go down. But if you get in a situation where you’re using your rescue medication (that bronchodilator or albuterol) more than every four hours for a couple of days, when before that, it was an infrequent sort of thing, that should key you into the fact that you need to talk to the doctor about what’s going on. Is there an infection that needs attention or do you just need a boost in your asthma medication? I don’t know if your doctor gave you a peak-flow meter to have at home.
Pam:
Yes, I have a peak-flow meter at home, and quite frankly I haven’t had to use it because albuterol and Flovent seem to do the job. I notice on occasion if I forget to take them, that I start feeling a little tight, and I don’t even have to use the peak-flow meter, I know I’ve got to go find that medication and administer it.
Dr. Shapiro:
Well, people differ on how much they need to use a peak-flow meter. Many people find that if they use it every morning routinely, like when they brush their teeth, it’s just part of life. They can catch a drop in lung function before they even have symptoms, and that allows them to be more vigilant. Perhaps use more albuterol, perhaps increase the amount of inhaled corticosteroid they use right away. And it may help them to get through an episode and sort of abort it without having it become a major thing. So the peak-flow meter is certainly a way to monitor how bad you’re getting when you’re having a problem, but it can also be a way to be tuned in early so that you can try to keep something from becoming a major problem.
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