Asthmatic, have bad allergic reactions, symptoms recur post treatment, sputum mucopurulent. What could be wrong?
Patient: i have had late diagnosed asthma 30 yrs old - recently i have been having very bad allergic reactions - couching consistaly , runny nose , producing sticky clear sputum . raised eosinophils 2.5 x 10*9L going on for a year. 3 years ago i had polyps removed from my nose, had very bad sinusitis and produced green nasal discharge. I use flixonase. i have been treated for a fungal lung infection twice. symptoms re-occur after about 10 days when treatment complete.i am constantly wheezing, unable to walk up one flight of stairs 14 steps without having to rest and use ventolin inhaler. My peak flow has always been good - swam competitavly until 20yrs and15 and 800 meter runner, was 500ml now 300 and one episode where 150. o2 stauration 95% sometime slightly lower. have recently needed to use inhalers x 4 times 2 puffs ventolin and symbacort. i am worrried that somthing else may be wrong. My sputum was mucopurulent when tested.thankyou for any insight i will be seing my dr in 2 weeks y Doctor: Hello, Thank you for writing to us at Healthcare Magic.  The rased eosinopihil count, constant rhinitis (runny nose), mucopurulent discharge does suggest an allergic rhinosinusitis. A fungal rhinosinusitis needs to be excluded. I am certain you had allergy testing of some sort, either specific IgE blood test or skin prick tests. If you have not had any allergy testing, it is important that the triggers are identified so avoidance, optimal medical treatment and or immunotherapy will help control the allergy.  It is also important that immune deficiency (antibody deficiency) is excluded with serum immunoglobulins, functional antibody levels. A sweat test may be indicated depending on chest findings (i.e., if there is lung scarring or bronchiectasis) then yes, the test is indicated. Your asthma needs to be optimally treated with combination inhalers. Please consult the online Asthma Control test (ACT) to see your current status.  Best Wishes.