question-icon

Suggest Treatment For Acute Bronchitis

default
Posted on Tue, 10 Oct 2017
Question: I have been sick for most of the last couple months. I have asthma and allergies and live where we have been having very bad air quality due to forest fire smoke for a couple months. Three weeks ago was diagnosed with acute bronchitis and had 5 days of prednisone. A phone line nurse last week told me I seem to have a viral infection since I started with a couple degrees of fever and two days later went over a degree below normal. I also have had a VERY sore throat when I swallow and red eyes, cough, feel miserable, oh, cough is wheezy and mostly at night. I have NO energy. The new symptom noticed yesterday am is a slightly protruding lump directly centered under my chin. It is fairly firm. Any ideas?
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (2 hours later)
Brief Answer:
Information

Detailed Answer:
Hello XXXXXXX

I have asthma and allergies too and can relate - sorry.

Soot from fires can definitely be a respiratory irritant, and considerably more so for someone with asthma.

I have a few thoughts on what might be going on:

1. If you have a cough and wheezing (or a wheezy cough), most likely your asthma is not under good control. Do you have an allergist who can do an in-office assessment of your FEV1 (a type of pulmonary function test)? Most likely you need to be on something other than just a short acting bronchodilator (i.e. other than the albuterol). Has your doctor talked with you about an inhaler that combines a long acting bronchodilator (such as salmetrol) with an inhaled corticosteroid (such as fluticasone)? Advair is an example of this type of inhaler. It does NOT help for acute attacks but might get your ongoing respiratory symptoms under control. It does not work immediately. You may still need to use the Albuterol occasionally for acute relief. The problem with a short acting bronchodilator like albuterol is that if used frequently/regularly, it becomes less effective (something known as "tachyphylaxis"). So it should really only be used sparingly.

2. You may have a cold going on on top of all of this if you also have a low grade fever. That will make the breathing worse. It can also cause an enlarged lymph node due to drainage in the region. Usually these are kind of sore from inflammation. Keep an eye on it though as a new lump should be examined if it is not at all sore. Without being able to feel it and know the size, mobility and consistency, I am only guessing here that it is an enlarged lymph node related to upper respiratory (sinus/throat) drainage. It could be a sebaceous cyst or lipoma (both benign).

3. Finally, after all of this... I recommend you go in to an urgent care clinic and get your throat swabbed for a rapid strep test and then sent for a culture. Because the combination of having a fever plus a VERY sore throat raises the concern that this could be strep throat. And that does need to be treated with an antibiotic to prevent the risk of complications from untreated strep. A rapid strep test can be done within minutes while you wait. While you are there, talk with the doctor you see about considering a combination steroid/LABA inhaler if you are needing to use your albuterol on a daily basis. And ask him/her to feel that lump.

Given that you have a somewhat complicated history here, I highly recommend that when you go in to the urgent care, you ask specifically to be seen by a physician (doctor). I am saying this because many urgent care clinics staff mostly with physicians assistants and nurse practitioners because it is cheaper for the clinic and there aren't as many doctors to go around. You need to be seen by a real doctor.

I hope this information helps. Please let me know how you are doing after you have been evaluated as above.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3134 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

152 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Suggest Treatment For Acute Bronchitis

Brief Answer: Information Detailed Answer: Hello XXXXXXX I have asthma and allergies too and can relate - sorry. Soot from fires can definitely be a respiratory irritant, and considerably more so for someone with asthma. I have a few thoughts on what might be going on: 1. If you have a cough and wheezing (or a wheezy cough), most likely your asthma is not under good control. Do you have an allergist who can do an in-office assessment of your FEV1 (a type of pulmonary function test)? Most likely you need to be on something other than just a short acting bronchodilator (i.e. other than the albuterol). Has your doctor talked with you about an inhaler that combines a long acting bronchodilator (such as salmetrol) with an inhaled corticosteroid (such as fluticasone)? Advair is an example of this type of inhaler. It does NOT help for acute attacks but might get your ongoing respiratory symptoms under control. It does not work immediately. You may still need to use the Albuterol occasionally for acute relief. The problem with a short acting bronchodilator like albuterol is that if used frequently/regularly, it becomes less effective (something known as "tachyphylaxis"). So it should really only be used sparingly. 2. You may have a cold going on on top of all of this if you also have a low grade fever. That will make the breathing worse. It can also cause an enlarged lymph node due to drainage in the region. Usually these are kind of sore from inflammation. Keep an eye on it though as a new lump should be examined if it is not at all sore. Without being able to feel it and know the size, mobility and consistency, I am only guessing here that it is an enlarged lymph node related to upper respiratory (sinus/throat) drainage. It could be a sebaceous cyst or lipoma (both benign). 3. Finally, after all of this... I recommend you go in to an urgent care clinic and get your throat swabbed for a rapid strep test and then sent for a culture. Because the combination of having a fever plus a VERY sore throat raises the concern that this could be strep throat. And that does need to be treated with an antibiotic to prevent the risk of complications from untreated strep. A rapid strep test can be done within minutes while you wait. While you are there, talk with the doctor you see about considering a combination steroid/LABA inhaler if you are needing to use your albuterol on a daily basis. And ask him/her to feel that lump. Given that you have a somewhat complicated history here, I highly recommend that when you go in to the urgent care, you ask specifically to be seen by a physician (doctor). I am saying this because many urgent care clinics staff mostly with physicians assistants and nurse practitioners because it is cheaper for the clinic and there aren't as many doctors to go around. You need to be seen by a real doctor. I hope this information helps. Please let me know how you are doing after you have been evaluated as above.