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Suggest treatment for wheezing cough

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Posted on Mon, 14 Apr 2014
Question: I have a viral infection and apparently it has triggerd a wheezing cough and a nonproductive cough. I was put on Z-pack last Friday b/c I was running a temp and I guess the PAC thought it was bacterial, but I was still running a temp up until today. 100.5, 100.4, 99.8. Clear drainage from my nose. I was seen Monday by my family phys. and put me on Xoponex nebulizer treatment and Mucinex, 1200 mgs. in the AM and 600 in PM along with Mucinex DM. Yesterday I was in to see him again, and he decided to put me on Medrol Dose pack to try to help the wheezing and see if I could break up this cough to be more productive. I know it takes about 2 days for the steroids to kick in, but wish I knew why the larynx seems so tight. I do have asthma in the past. I completed the Z-pack yesterday and I know it stays in your body for 5 more days. I can see why the CDC wants medical professionals to be cautious with giving antibiotics. I don't know why the PAC did not wait until 7 to 10 days. My daughter is an epidemiologist in VT, and is always annoyed b/c you should wait 7 to 10 days before giving antibiotics. Can you please also give me your opinion. Much appreciated. XXXX
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Answered by Dr. Vivek Chail (1 hour later)
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX Thanks for writing in to us. I have read through your query in detail. There is a possibility that if you were first affected by viral flu and subsequently developed a secondary bacterial infection, the symptoms are often confusing and the doctor has to think further than treating a viral infection and add antibiotics like Z Pak. In the young population enough time can be taken to decide on when to start an antibiotic but in the elderly age group, starting treatment with antibiotic is done anticipating complications due to secondary infection. The decision to start antibiotics is not universal and depends on patient condition, age and medical history. I think Z Pak was started in your case in good faith and might be your symptoms were more towards a bacterial infection. Please do not worry, take adequate fluids to avoid dehydration. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (13 hours later)
Thank you for answering my inquiry. I am still concerned why my cough still is not productive even using the xoponex inhalation therapy, muscinex and muscinex DM. The z-pack should be in my body until Monday. I am also taking the Medrol dose pack until this Monday. What else can be done or do I have to wait to see if another antibiotic has to be given?
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Answered by Dr. Vivek Chail (1 hour later)
Brief Answer: Possibility of ?allergic bronchitis Detailed Answer: Hi XXXX Thanks for writing back with an update. It is possible that you might be having allergic bronchitis. If you have the condition, you must avoid exposure to possible source of allergens like dust, pollen and smoke. Medical treatment in allergic bronchitis includes the following. Short-acting bronchodilators, such as albuterol, to help open the airway to provide short-term relief Inhaled corticosteroids. Long-acting bronchodilators used together with inhaled corticosteroids Leukotriene modifiers Cromolyn or theophylline Combination inhalers containing both a steroid and a bronchodilator Salt water gargling twice a day is recommended for you to soothe the throat. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (11 hours later)
Thank you Dr. XXXXXXX once again. Just to update you, I cannot take Albuterol as it increased my heart rate to 98, and my BP went up to 188/94. Therefore, I was switchen over to Xoponex 1.25 in the nebulizer. I also have the inhaler to carry in my purse if I need to take it q 4 hrs. as needed. I am on the Medrol Dose Pack, Mucinex 1200 mgs. in the AM and 600 mgs in the PM and Mucinex DM in the PM if I need to quiet cough. I too wondered if my tight cough is more of an allergic bronchitis, as I am allergic to mold also. I rec'd the injection the day before all my symptoms started which is a week ago today 3/14/14. But because I had temps running from 99.4 to 100.5 for nearly 5 days, could this still be viral? Any mucus from my nasal passges are clear. I am also using the sinus rinse twice a day with distilled water to keep the nasal passages clean. Z-pack should be in my system until Monday 3/17/14 and I will have completed the Medrol Dose pack on Monday also. If you feel all what I am doing is fine, please let me know. Do you think after all this, I would have to be tried on another antibiotic? Especially if there is no discolored mucus? XXXX
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Answered by Dr. Vivek Chail (13 hours later)
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX Foschi-Unger, Thanks for writing in with an update. I find that you are taking necessary treatment. I still feel it could have been a viral infection with a mild bacterial secondary infection. The antibiotics given (Z pak) is good enough to control any infection. I do not feel there is a need for another antibiotics at the moment. You do need to protect yourself from the environment and dust around. Please drink enough water and fluids to avoid dehydration. Taking hot home cooked meals is recommended. Your persisting cough is most likely due to allergic bronchitis in my opinion. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (6 hours later)
Hi Dr. ViveK; I just want you to know I appreciate your taking time to answer my questions. The Z-pack should be out of my system on Monday, and the Medrol Dose Pack I will have also completed by Monday. I continue to use the Xoponex inhalation therapy q 4hrs. I plan to go back to work, as I work for St. Luke's Hospital in Bethlehem PA, the St. Luke's Physician Group. I work in the business office and we do all the billing for the physicians owned by the hospital. Is it a good idea to use my Xoponex inhaler q 4 hrs. while at work? I still wonder if getting the mold shot a day before I came down with this infection, made things worse? But who knows. My allergist did ask me to call him on Monday if my cough is still not breaking up, as he might have to increase the steroids. I hope not, as I don't like being on steroids too long of a time, but with allergy pts. and asthma pts. sometimes you have to until this corrects itself. I am not taking any Claritin or Coricidin HBP because I think the antihistimine might make my cough drier if I am correct. Can steroids produce a ringing in the ears and fluid retention? I suffer from Meniere's Disease periodically and watch caffeine, salt as I am on a HBP XXXXXXX with diuretic. But I don't want to get an episode of the vertigo, but I read that that could be a side effect of Medrol. How long can allergic bronchitis last? Should I continue with the amount of Mucinex I am taking? I don't know if you heard of the Doctors Program nightly? They are starting this being able to call a dr. on our Iphone and get advice, treatment, and prescriptions. I guess this is the new trend also. I think this program that you are involved in will help many people. I will be waiting for your answer. I worked in Neurosurgery for almost 30 yrs. and attended nursing school in the past years ago, but had to drop out 6 mos before graduation as my mother became very ill and I had to stay home and take care of her. I worked in ICU 2 1/2 yrs. also in the past. So I have been in the medical field since 1963. Worked in the OB/GYN residency program for the chief and director also at St. Luke's. Did consulting for ENT, Neurosurgery, Nephrology also. Help start up a surgi-center in Bethlehem Twsp. I know I have an extensive background, and am always trying to learn more, but when I myself get ill, you worry more because you are use to helping others. But now I have to worry about myself a little too. Thank you once again. XXXX
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Answered by Dr. Vivek Chail (15 hours later)
Brief Answer: Please find detailed answer below Detailed Answer: HiXXXX Thanks for writing in with an update. With the vast experience that you have you are taking care of yourself in the best possible way. I agree with your thoughts that as patients we are more worried because we know the complications of most conditions and fear the worst. Anyway you seem to be improving with each day and I guess in a week to 10 days you should be completely normal. It is suggested that you continue taking Xoponex inhalation therapy q 4hrs even at office as a preventive measure. Usually this medication should continue for sometime and not be stopped abruptly. Your allergist wants to play safe in any adversity. I don't think you may need higher dose of steroids than you are taking right now. Claritin or Coricidin HBP will cause dry mouth and this may also make the dry cough persist but it is not the same in every person. If you hydrate your self properly then you can take one of them. Also while taking Mucinex, it is advised to drink plenty of fluids and this will help to break up mucus and clear congestion. Allergic bronchitis may resolve in about a week's time and till then you may safely take mucinex. Concerning Mucinex please do not take more than 2400 milligrams in 24 hours. Do not increase your dose or take this drug more often than directed. Steroids will never cause Meniere's disease or fluid in the inner ear. As per latest treatments, steroids injected behind the ear drum give significant relief to patients of Meniere's disease. Though I have heard of Doctors Program nightly, it needs to be organized in a better way so as to give maximum benefit to care seekers. Prescriptions for chronic known diseases are acceptable but emergencies should not be missed and the patient must visit the ER urgently. Health regulators need to have a lot of discussions before prescriptions can readily be given over phone after confirming the condition. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (8 hours later)
Dear Dr. Chail: So good to hear from you again. And thanks for reassuring me I am getting better. I wondered if I could use my inhaler of Xoponex while I am at work? I will use the nebulizer before work and when I get home and before bedtime. But thought during the day as long as it is 4 hrs. from when I used the inhalation, I could use the inhaler (which I will always carry in my purse). Yes, I will only use 1200 Mucinex in the AM and only 600 at night. I haven't been using the DM anymore, as I am not coughing during the nite, unless I get up to go to the bathroom. I'm trying to drink as much liquid as I can to stay hydrated. I'll keep you informed. I have (2) more steroid pills to take, one tonight and one tomorrow morning than I am done. I still feel run down, but it will be 10 days tomorrow all this started. Maybe if the weather warms up a bit, everyone will feel a little better. Thanks again. XXXX
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Answered by Dr. Vivek Chail (15 hours later)
Brief Answer: You have almost recovered Detailed Answer: Hi XXXX Thanks for writing in with an update. I am pleased to assist you through you recovery to health. It looks like you are almost normal but for the weather conditions which seem to be difficult at the moment. Nice to know that you are maintaining hydration regularly. You may use the inhaler at office and the nebuliser at home. You can stop with the last of the steroid pills tomorrow. Your feeling run down is normal considering the severity of illness besides your age. Please wear protective clothes when going out in the cold. Further updates are most welcome. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (6 hours later)
Dear Dr. Vivek: Thank you once again for giving me your medical expertise. It was good to get back to work, even though I am still not 100% myself. But I'm use to being a very energetivc 68 yr. old and am not once to just sit. I like to keep active. But I will have to let my body get a little stronger. Lower back hurts and feels sore, probably b/c I am sitting at my desk in a week. Even though I have been getting up and down. I will continue the use of my nebulizer this week yet and see how well I do. Also completed the steroid pack today. Will continue on the mucinex. Only taking 1200 in the AM and 600 in the PM. Maybe I really don't have much mucus to bring up, as I don't seem to bring any mucus up. It sounds a little more loose, but maybe as you said in the beginning, it could be the irritation in the airway and larynx. I just hope I am not infected as my grandchildren are coming from Vt next Thursday, a week away. I'll keep you informed my progress. thank you again. XXXX
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Answered by Dr. Vivek Chail (20 hours later)
Brief Answer: Welcome Detailed Answer: HiXXXX Thanks for writing back with an update. I am sure you will be back to normal when your grandchildren visit you a week later. The medications seem to be working fine. It's great to know that you keep yourself busy through the day, this will help you in recovery. Please keep yourself away from house dust, smoke and pollen. Do update me at your ease and I will be glad to hear from you. Reagrds, Dr.Vivek
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Suggest treatment for wheezing cough

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX Thanks for writing in to us. I have read through your query in detail. There is a possibility that if you were first affected by viral flu and subsequently developed a secondary bacterial infection, the symptoms are often confusing and the doctor has to think further than treating a viral infection and add antibiotics like Z Pak. In the young population enough time can be taken to decide on when to start an antibiotic but in the elderly age group, starting treatment with antibiotic is done anticipating complications due to secondary infection. The decision to start antibiotics is not universal and depends on patient condition, age and medical history. I think Z Pak was started in your case in good faith and might be your symptoms were more towards a bacterial infection. Please do not worry, take adequate fluids to avoid dehydration. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek