Methacholine Challenge
Question:
> The previous post from "xxx" is a testimonial to the monster that the > MD-worshippers have created.
Anyone who "worships" MDs is indeed a fool. There are great ones, ordinary ones and horrible ones, just as in any discipline. That’s why the input of knowledgable, informed people – both professional and lay – on this group is so helpful. Patients who dont have the time or background to keep up can see if their doc is vaguely in line with the ’state of the art’. If not, he/she may have a perfectly good reason, BUT info posted by people like Colin, Bill, etc gives the patient a basis for asking rational questions. I teach med-students. Believe me, "worship" is absolutely the last response they evoke in those who know them.
Response:
It sounds like the first thing you need is a new doctor. When I was diagnosed I was the one who thought it didn’t happen to adults. My GP did! As for your PEF values of 350. Maybe it’s because you use a different device to me. However 350 for someone 5′7" seems low to me, although you don’t way how old you are and I reckon there is some technique in using the PEF meter. Maybe also I’ve got used to my values which may be above average. Some of the drugs & inhalers need to be used for a period of time to become effective – up to 4 weeks – and need to be continued once control is gained. They don’t cure asthma – they control it. Once you have good control you may be able to slowly reduce the dose, taking care to measure your peak flows to ensure control is still there. Hope a new doctor helps. Hope you can get hold of one. The first doctor I saw when I started coughing gave me antibiotics and said there was a lot of it about. She omitted to say I should come back if the cough failed to get better or I got night-time wheezing. Happily the second doctor I saw seems to know about asthma so I stick to seeing him for that sort of problem. – Hide quoted text — Show quoted text ->I have been coughing day an night for over six years. (I think I was >coughing even before this but it was only at night.) In 1994, an allergist >I went to hinted but never confirmed that I might have asthma and I have >been on almost every asthma drug and inhaler since Nov 1994, including >singulair and accolate and two brief doses of prednosone. Some drugs would >help for brief periods but the coughing always returned and the drugs would >lose their effectiveness. The doctors never really monitored me and never >seemed to take my condition very seriously, although the coughing totally >interfered with my life – my job, relationships, where I lived. I live in >an apt and I fear disturbing my neighbors at night so I have slept on my >couch for almost a year. I went to a dentist recently and the cough drops >have done severe damage to my teeth. >I have been sicker than ever later, perhaps the effect of El Nino. I am >hoarse and coughing like crazy. Anyway my primary physician referred me to >another allergist. The allergist thought I might not have asthma as the >steroid drugs didn’t seem to help me in the past. He suggested it might be >vocal cord disfunction and was surprised that the previous allergists had >never had me take the methacholine test. He got me in the very next day to >take the test. Well, the technician told me that I tested positive – my ftv >went down by 20 percent or more. I went in and wasn’t coughing too badly on >this day but as they had me inhale, I began to cough and went into into >spasms. I usually feel the spasms in my trachea (the allergist said that >the trachea is collasping when this occurs). I was given albuterol in the >nebulizer and my ftv came back up. >I’m hoping that now that my condition has been verified that I will be >monitored. You really have to fight the system. Earlier this year I asked >for a CT scan of my sinusesto see if they could be the cause of my problems. >They didnt’ want to do it. I told them that my dad had died of sinus cancer >and no one did a CT scan on him until it was too late. They just kept >telling him that it was his sinuses and gave him more medicine to inhale >through his nose. Only when I told them that I had a deviated septum did >they let me have the CT scan. The CT scan did not show any indication of >sinunitis and the ENT told me that there was nothing he could do for me. >This allergist says that asthma is rare to occur at adult age. I have been >reading this ng for three years and I know that it is not the truth. Even >news reports say that the numbers are increasing. I worry about a doctor >who believes that it cannot occur at any age. I have come to believe after >my father’s death and my problems that medicine is not a science, hardly >absolute. I believe that people can differ than what’s in a medical book >and still have that problem. The first allergist I went to said that only >children cough with asthma, had me breathe into one of the those whatever – >I scored 350, he said that was consistent with my height of 5′7", therefore >I did not have asthma. It was not like I could be ok that particular day. >It was crazy. On my own I have had as high as 450 on good days and 150 on >really bad days. >I’m just mad and frustrated and wanted to vent. Thanks for listening.
– Surfer! http://www.nevis-vieww.demon.co.uk http://www.nevis-vieww.demon.co.uk/flash Hopeful anti-spam: alter double ‘w’ to single ‘w’ to view site & send Email.
Response:
> This allergist says that asthma is rare to occur at adult age.
As it turns out, approximately 1/3 of all asthma cases are diagnosed for the first time in adults. Asthma indeed can occur in adults, and this is something that pulmonologists, allergists and primary care physicians need to appreciate. Steve White, M.D. U of Chicago Reply to: stevewhite at ce dot mediaone dot net
Response:
- Hide quoted text — Show quoted text – > I was tested for allergies in 1994. I was allergic to dust, molds, pollens, > small animals, and probably a few things I can’t remember (grasses probably > being one of them). Although the testing is in my file, this allergist has > scheduled another testing for this Thursday. > The allergist said that it was quite rare to get asthma as an adult. He > asked me if I had bronchitis in 1992 prior to when this all began. I said > no but I racked my brains out last night and remembered that I got a bad > cold in Mexico just prior(maybe a month) to when this coughing all began. > But it wasn’t bronchitis – I didn’t cough, I just had really bad sneezing > and constantly blowing my nose. I had problems in Mexico with the pollution > and my allergies had bothered me. My friend had first caught a cold midway > during the trip and then I got it on the last day. I remember it because it > lasted two weeks but the mucous wasn’t green or yellow. We took a bus all > night from the town near the Copper Canyon to San Diego. I fell asleep with > my head against the cold bus window and woke up with the cold and an earache > during the night.
Perhaps it started out with an Upper Respiratory Infection; which then migrated into the lungs causing Acute Bronchitis with coughing; which then turned into cough-variant asthma. This seems to be a common occurance with adult onset asthma. This is what happened to me, in ‘89. URI, bronchitis caused by a virus so mucus was not discolored, eventually ended up in ER with adult onset asthma. http://www.njc.org/MFhtml/URI_MF.html Upper Respiratory Infections (Colds) and Acute Bronchitis Links on Adult Onset Asthma: http://www.asthma.org.au/html/adult.htm ADULT ONSET ASTHMA Excerpt: "What triggers adult onset asthma? The real cause of asthma (childhood or adult onset) remains uncertain. We don’t understand why symptoms develop at a certain stage, or why they might disappear. That’s why research is so important. Adult onset asthma can be aggravated by trigger factors similar to those of childhood asthma. The first priority if you have asthma is to identify and avoid the trigger factors which affect you. Keep your home or workplace as free of asthma triggers as possible. These Include: Allergens which are substances that trigger an allergic response. Common indoor allergens include cats, feather bedding, mould on walls and household dust mite. There are steps that can be taken to help reduce exposure to them. Tobacco Smoke. If you have asthma as an adult, smoking is more likely to cause your lung function to deteriorate very quickly and permanently. Once that happens, asthma medication cannot reverse the condition. Viral Infections such as flu or colds commonly trigger asthma. They cannot easily be avoided. Influenza vaccination will not prevent ordinary colds, but for many people with chronic respiratory conditions, vaccination is advised to reduce the risk of influenza-pneumonia which may be quite severe if you have asthma. Dusts can irritate your nose, throat and lunks. If you have asthma it is best to avoid dusty occupations such as baking, woodwork, metal foundry work, mining, etc. Fumes and strong odours, including perfume, can aggravate asthma. Avoid spray products if they were a problem. Industrial by-products such as spray paint fumes can cause or trigger asthma. Medications. Beta-blockers are used for treating high blood pressure, angina or glaucoma. They should not be used if you have asthma as they aggravate the condition. Aspirin and other pain relievers called non-steroidal anti-inflammatory drugs (NSAIDSs) are also best avoided. Make sure that your doctor and pharmacist know that you have asthma so that they can avoid giving you medications which may aggravate your asthma. Foods. Some people are sensitive to food additives, commonly sulphites (coded 220 to 228) which are used as preservatives in foods and drinks. Occasionally adults are sensitive to certain foods such as peanuts, eggs, seafood (particularly shellfish), nuts, wheat and chocolate. Milk and dairy products rarely trigger asthma." For more information contact the Asthma Victoria, your doctor or pharmacist. Link to Expert Panel Report 2: http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/pathog… Airway Pathology and Asthma Excerpt: "Adult-Onset Asthma Although asthma begins most frequently in childhood and adolescence, it can develop at anytime in life. Adult
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