Cough for more than a month

[Willow1006]

Hello,
This is my first post on mumsnet.
I’ve had moderate asthma since i was a child and was hospitalised many times in childhood due to this

I’ve had a cough now for 4 weeks which isn’t improving.
Initially, I had a chest infection which got better with antibiotics and steroids (due to me having asthma).
However, I had another chest infection which was much worse than the initial infection where I had very loud wheezing and crackles. I made GP appointment and I was given the same antibiotics(amoxicillin) and steroids as well as the same dosage. This made no difference and for the past month, my sleep has been heavily disrupted due to coughing and wheezing. Last Tuesday I had a chest x ray and was put on clarithromycin. Chest X ray came back clear but I’ve still got these crackles ,wheezing and coughing attacks.

what do i do?

I was hospitalised with asthma/flu and had crackles for quite some time after even on antibiotics. GP told me it could take up to six weeks to clear but I suggest you call them again. How is your peak flow?

Hi,
To be honest my peak flow always hovers around 200-250 when it should be 400 (164 cm F)
I’ve noticed a drop to 150. Should I be worried?
I do wonder what the doctors could do further and I don’t want to keep hassling them with this same problem.

Would also like to add that these crackles and wheezing is affect the right lung more than the left lung and the cough literally takes my breath away and is productive

150 is low for peak flow. Have you been using your Salbutamol? You can take up to 10 puffs over 10mins using a spacer and see if that helps but if not I'd try to get an appointment with out of hours as you probably need more prednisolone. It sounds like you still have an infection and maybe need a different antibiotic. Did your GP not suggest a Sputum sample to see which antibiotic would be effective? When you've already had several courses of antibiotics this would be best. Hope you improve soon.

After 2 rounds of high doses of steroids (8 tablets for 4 days) as well as increasing Clenil 200mg to 4 puffs twice a day I have seen very little effect.

Salbutamol only works for a small amount of time (like 1hr) and I’m back to having the crackles.

The doctor didn’t mention a sputum sample and decided to do chest x ray instead but came back clear. Although the previous doctor I saw before my 3rd visit said to me if your symptoms don’t improve or are having frequent exacerbations that I’d be referred to a chest clinic. I would need to see this doctor again as she treated me twice however she is off Ill.

I did also have a blood test and found high reactive lymphocytes? I have no idea is this means anything in relation to this?
Thanks for your response 😊

A blue inhaler usually lasts me around 2 months but I’ve managed to use 1 in 3 weeks, which isn’t good because my body is almost relying on salbutamol to open my airways

I'd ask your GP to do a sputum sample.

I've had chest infections for over 70 years now, and my GP, on my advice, always now prescribed doxycycline, following a sputum sample a few years ago.

doxycycline is, in my opinion, evil shit, but it works for me. Amoxicillin, not so much.

I think the high reactive lymphocytes are indicative of an infection. If Salbutamol is only lasting an hour you definitely need help, as I said I'd try to get an out of hours doctor appointment. I've been admitted to hospital with a peak flow similar to yours and wheezing and honestly getting nebs, prednisolone and a stronger antibiotic makes a huge difference. Also see your GP as well as you can be put on additional medication like Montelukast and/or a combination inhaler like Seretide.

Hi everyone
I honestly don’t know what to say
I asked my doctor to switch my controller medication but she said no and increase the dose of clenil
Montelukast was once the bane of my life, I couldn’t handle the side effects of it so I asked to be taken off it a year ago.
When I asked my doctor the 3rd time if I should go to the hospital for a nebuliser he said no because my oxygen levels were 96 at that point and claimed the asthma wasn’t affected

I was once prescribed doxycycline around 2years ago from my actual family gp but he isn’t as available as much now so it’s very hard to get an appointment with him.

There are many locum doctors at the practice that keep changing so they don’t know my full history

I find that amoxicillin isn’t as effective
I don’t know if it’s due to the dosage as the doctor I saw the first time didn’t take into account that I was an asthmatic despite me telling her, so prescribed a very low dose which didn’t really help

Can you make an appointment to see the asthma nurse instead of a GP? They can prescribe medication and are usually more clued up about asthma than doctors. It's a shame you don't get on with Montelukast but a combination inhaler with a long acting b2 agonist along with a corticosteroid would be the next step in trying to control your asthma. Then there are other medicines like Tiotropium (Spiriva) which can be added on if necessary.

I've always been admitted to hospital on the basis of a significant reduction in peak flow rather than oxygen levels.

A peak flow of 150 is very low. It sounds as if your asthma isn't being treated effectively. To be honest, if that were me I would have called the GP again today or out hours this evening. In any case, a referral to a lung clinic would be a good idea. My lung consultant said Montelukast isn't terribly useful and he tends not to prescribe it. I also have to have a 10 day course of antibiotics plus 7 days prednisolone and often repeated. Keep a really close eye on your peak flow and I wish you the best.

I requested several times to see an asthma nurse but the dr said there’s no point because recording a peak flow can cause lung injury? I felt like she kept fobbing me off. I do appreciate gp appts being 10 mins but the entire consultation felt rushed.

When I asked for an alternative to montelukast the doctor said there wasn’t and that the medication I was on was sufficient… I don’t believe that this so the case.

I will ring them up tomorrow and get an emergency appt and really push for more controller medications and the referral to the ling clinic.

Thank you all for your help and detailed responses 😊

Bit of a long shot, but are you wing sick too when you cough? I had a bad chest infection and it just continued after amoxicillin, which did zero, I then started vomiting and queried whooping cough. Had to have a blood test and then DH started with the same symptoms ... yep both positive
... just a thought!

I’m sorry but could you clarify what you meant by wing sick

Whenever I cough, I cough to the point that it’s so hard to breathe and I have to use my lower chest and stomach muscles to cough all the phlegm and mucus out. Coughing attacks don’t last long but they’re very repetitive
i have at least 4 in an hour and it’s worse at night
I’ve done my best to eliminate any environmental factors such as dust to not further aggravate my asthma.

Also when I breath in my airways become so irritated so I have to cough and have to bend over to get all the mucus out. I’m just concerned about the right lung and why it’s more affected then the left lung

Have you tried the huffing technique? Easily found if you google. I was taught it before I left hospital as mentioned above. I used it a few months ago and it literally saved me from going to A&E as I couldn’t clear my airways. Usual proviso of checking with a health professional to see if it is suitable for you.

Yes I’ve done the huffing technique many times but I find that coughing due to the huffing really irritates my airways

prior to this illness I did used to do a wide range of breathing exercise to strengthen my lungs

Wing sick = being sick (stooopid iPhone!)

www.cdc.gov/pertussis/about/signs-symptoms.html#:~:text=One%20to%202%20weeks%20after,common%20as%20the%20illness%20continues.

I forgot to say about the noise when whooping too which van be the give away

Hmm
I feel like it could be a whooping cough but I’ll only know once the doctor has done the necessary tests
thanks for the informative link
after every coughing attack I have to gasp, is this part of the condition?

And also how is the whooping cough detected in a blood test is there a specific test for it or shall I request a sputum sample or both ?
Thanks for your responses😊

Also are there any tips to reduce the thickness of the mucus that I cough out ?

I think it's a swab for whooping cough but I'd ask for a sputum sample too as the antibiotics you've had so far haven't worked. Doxycycline or Co-amoxiclav often work better, depending on the bacteria. Drinking lots will thin the mucus and avoiding dairy might help too. Re the asthma nurse, at most surgeries you can just phone up and ask for an appointment with the asthma nurse saying your asthma is poorly controlled.