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Bad cough and nasal congestion. A Dr prescribed Flovent, Fluticasone, another told Dulera. Which one to use ?

I have been sick for several weeks with a bad cough and nasal congestion; have seen 3 different doctors. The first put me on Loratadine for allerigies even though I have never had any sort of allergies. It did nothing and 3 weeks later I was just as sick. So I saw a different doctor at the same place and she prescribed me Fluticasone nasal spray , and gave me Flovent for ashthma as well as Pro-Air. I had never been tested for asthma before this. The Pro-Air as a rescue inhaler definitley helped me breathe better when going through an attack bu today my home doctor prescribed Dulera and an antibiotic. Should I stay on the Flovent or try the Dulera? Should I continue with the Fluticasone or stop and take the antibiotic?
Asked On : Fri, 9 Nov 2012
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General & Family Physician 's  Response
Thanks for your query.

Your words suggest you were having an upper respiratory tract infection with respiratory distress.
The antibiotic was prescribed to treat the infection considering it to be bacterial infection.I hope your doctor did throat swab culture sensitivity testing and some blood investigations.

Flovent , Dulera , Pro-Air all all were given to you to relieve the asthmatic symptoms.
Flovent contains fluticasone. Dulera contains Mometasone + formoterol . Pro-Air contains salbutamol.
fluticasone and mometasone are steroids and their function is to decrease the inflammation. Salbutamol is short acting selective beta 2 agonist , it acts as bronchodilator for shorter duration and relieves the respiratory distress.
Formoterol is a long acting beta 2 agonist , acts as bronchodilator for longer duration.

The fluticasone nasal spray was given to you for your nasal congestion.

So you can see all these medicines have their own actions.

If you are having wheezing and respiratory distress all day long then its better to shift to fluticasone + formoterol inhalation twice daily and use salbutamol inhalation on emergency basis during the asthmatic attacks.Antibiotics are to be used if there is infection which will be diagnosed by your treating doctor.

Hope this helps.

Update here how you stay.

Take care.

Disclaimer: The Expert’s advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place.Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Answered: Fri, 9 Nov 2012
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General & Family Physician Dr. Md. Harun Ur Rashid's  Response
Thanks for your query and Welcome to HCM forum.

Asthma or something else ?

A bad cough and nasal congestion can be associated with various medical conditions. The most common is seasonal allergic rhinitis with post nasal drip syndrome, new onset asthma with allergic rhinitis. Lack of specificity of symptoms make the diagnosis difficult. However Episodic symptoms, Characteristic triggers, Family history of allergy favor the diagnosis of asthma. Certain features reduce the probability of Asthma like lack of improvement following anti-asthmatic medications, history of cigarette smoking. For a definitive diagnosis several investigations are useful e.g. peak expiratory flow rate (PEFR), Spirometry, Bronchodilator response, chest radiograph, complete blood count (CBC) with differential white blood cell etc.

Flovent + Pro-air or Dulera ?

As Anti-asthmatic medication improves your breathing problem, it might be New onset asthma, but not definitive. Asthma and Rhinitis ( Nasal congestion) are friends. Most frequently they go together. Dulera is more potent and long acting medication than Flovent+ Pro-air. We prefer to initiate therapy with a less potent, quick and short acting drug in previously untreated patient. However you can follow your doctor what you think best.

Antibiotic ?
Role of antibiotic in prophylaxis is debatable but i think it prevent things from getting worse.

Hope you have got your answers. Wish a quick recovery.
Answered: Fri, 9 Nov 2012
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Disclaimer: These answers are for your information only and not intended to replace your relationship with your treating physician.
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