Constantly clearing throat.

[Margaretindevon]

I am on Fostair 200/6 two puffs twice a day with Salbutamol as a reliever. I had a flare up a couple of months ago and since then have been troubled with a lot of phlegm in my throat, which I cannot seem to cough up or clear. I am constantly clearing my throat and it is getting sore. I rang my Dr and had a telephone chat with her and she is trying me with Montelukast. I don't think it is making any difference, but have found that taking a puff of Salbutamol helps. I know you are not supposed to take that more than three times a week. I already take a antihistamine. I'm 84 and also suffer with Thyroid problems and GERD. Does anyone have any ideas for something to help with the phlegm please?

[Celbie]

Hi Margaertindevon, I am having similar trouble on and off through the years but it became markedly worse over July wherein I realised I seemed to be reacting to grass pollen which I've not noticed before. It was so bad my throat became extremely hoarse and husky and I had a very tight chest. I have researched so much and to be honest there are so many possibilities. The big one being possible allergy. Allergy test years ago for me came back negative I may get it repeated and I suggest you may also benefit from allergy testing. If you can identify a trigger, you can treat it more accurately.

It sounds though like your airways became reactive and it hasn't quite settled yet?

In the meantime, I notice a combination of a few things help....

I got a humidifier and small air purifying unit for my bedroom. I damp clean and hoover all of the room and change the bedding weekly to reduce dust and improve the air quality in my room. etc.

I find drinking lots and lots of water helps.. some recommend warm water with a squeeze of lemon to loosen the phlegm and make it easier to clear. Warm liquids in general seem to be the recommendation. I am drinking some herbal teas with liquorice and mullein which I read helps somewhat with mucus in throat.

Gargling warm water helps a little also.

A warm shower also helps because of the warm steam loosening the mucus, but steam affects asthma in variable ways for different people so obviously all this comes with that caution.

I also read that specialists advise against constant throat clearing...I think it can perpetuate the problem and cause more throat irritation. Sucking lozenges helps a bit as you are focused on different mechanisms to throat clearing etc .

Apparently swallowing a gulp of water forcefully can help dislodge mucus without irritating the airways. Some voice trainers advise this. For me, this technique didn't work and also caused burping.

I also believe that having poorly controlled or silent reflux can add to the irritation, so making sure that's addressed is important through correcting your diet, possible medicines and positioning in bed.

Medication wise, I was unable for some of the oral anti histamines...they dried my airways too much, so I started on Dymysta nasal spray which has fluticasone and and anti histamine. It took about 10 days, but it definitely improved my symptoms.

When things are particularly bad I also use Neilmed saline nasal rinses to clear the mucus.

It is such a frustrating condition but hopefully with trial and error and time, you will figure out the best solution. What I would advise is to make sure you give any change in medication time to work as they take a little longer to take full effect than you would imagine.

[Margaretindevon in reply to Celbie]

Thank you for your very helpful reply. Could I ask where you got your allergy testing done and what it entailed please?

[Celbie in reply to Margaretindevon]

I live in Ireland, so I got mine done through a private consultation with a respiratory consultant in a private hospital in Dublin. It entailed a series of skin pricks of various allergens under the skin...quite a few. It was a good few years ago but I think things have changed for me now.

[Troilus]

Hi Margaret. The amount of salbutomol is just an indication of how controlled your asthma is. You can take more.

It sounds to me as if your asthma hasn’t quite settled yet, since your flare.

As you have spoken recently to your GP, she is obviously aware of this.

I often take a shot of my blue inhaler if I have phlegm I can’t clear. It opens the airways making it easier to get rid it. I wouldn’t worry about taking more than 3 a week while you are getting yourself back on track.

[twinkly29]

GERD can definitely be a cause of mucus so it could well be that.

Please don't not use Salbutamol though if you need it for your asthma - as Troilus said, the ideal is not to need it more than 3 times a week but needing it is very different from just not using it! If you need it, use it. If you're regularly needing it more than 3 times a week then speak to your GP about a review.

[alnew45]

I have this problem too, for the last 4 or 5 years! Been prescribed steroid nasal spray and recently Montelukast. It didn't work for me although I read that it's a miracle drug for some. So if anyone has any answers, I would be interested too! It's very embarrassing and interferes with normal life and sleep.

[Dachshund1]

Hi Margaret I have had terrible trouble with mucous and was carbacistiene and Monte Lucast it needs a while to work and it helped me a lot and I also use a air physio device which I find is great for me as it loosens the mucous every time I use it

[Itswonderful in reply to Dachshund1]

Can I ask which flutter device you use?

[Margaretindevon in reply to Itswonderful]

What do you mean by a flutter device please? I have never heard of it.

[Itswonderful in reply to Margaretindevon]

Hello again. I may have misread your original post but I thought you mentioned a device that you breathe into and it helps clear your stuck mucous?

[Itswonderful]

Good morning. Have you ever seen a respiratory physiotherapist? They may be able to help with breathing techniques to loosen the mucus in your throat. The throat clearing that you are doing might be exacerbating the feeling of wanting to clear your throat by irritating the vocal cords. Sipping water throughout the day will lubricate your throat and drinking enough of it which is usually a lot more than you think, with water the mucus down and make it easier to move and then it can be swallowed, which is what happens naturally though it sounds yukky, without irritating the throat further.

[Cay5]

If you have GERD then it is most likely that that is causing the mucus. I take montelukast and use fostair inhaler and have no problems with them. But I do have similar problems with my throat and coughing. I have since discovered I have LPR SILENT REFLUX. THe symptoms are hoarseness and weakness of the voice, excessive throat clearing, excess mucous in the throat, nasty taste in the mouth, difficulty swallowing, heartburn and indigestion, and a few other symptoms. It also makes asthma more difficult to control. There is information online at uhcw.nhs.uk Diet can help but I also take Lansoprazole in the morning which helps. It might be worth checking to see if this is the cause of your problems too.

[Margaretindevon]

Thank you all for your help. I am learning a lot, and it is nice to know I am not the only one, though I am sorry for you all too! I take Omeprazole 20mcg twice a day, and my Dr said she dare not give me any more. I do need to lose some weight, but at 84 with two replacement hips and a screwed together right leg exercise is not on the agenda. I suppose I should just accept I am old, but I am only 19 in my head! I've just learnt I am to be a Great Grandma so I have to stick around for a while to teach him/her all the things you do to wind up parents!

I have not seen a respiratory physio, but will keep that in mind. I also think you are right in that the more I clear my throat the more irritated it gets, and I will try drinking more water.

I have just read I should avoid mints, and I have been eating them by the handful to try and clear the mucus. That will stop. If I possibly can I would like to rid myself of this by natural means, I take enough tablets as it is. Has anyone any experience of the electrically adjustable beds please? I don't think I can raise mine on blocks at the head, and they look like a good solution for someone my age.

Thank you again for replying. It's been such a help.

[Superzob]

I tried Montelukast, but it made me very drowsy. I take N-acetyl cysteine, which is similar to the prescribed carbocysteine, but available from health stores; I think it makes some difference, but not all the time.

I would have a word with your GP about salbutamol; it's a pretty safe drug and, if it works for you, I don't see why you can't take it up to its maximum dose. I was diagnosed with late-onset asthma after 6 years of incessant winter "colds", only to discover that continuing my hayfever nasal spray during winter actually stopped this; nobody understands why, but it works for me, so I'll continue to do it at 1/4 of the prescribed dose!

[Lysistrata Administrator Community Ambassador in reply to Superzob]

I have nasal problems/rhinitis in winter as well as during hayfever season (spring for me), and need at least the same dose of my steroid nasal spray in winter as in spring. I had to work this out myself, but I assume it works because it's still rhinitis and the steroid spray works regardless of the cause. Not sure what triggers mine, especially since my asthma is non-allergic, but it's there.

I absolutely agree for Margaret, as you and others have said, that if you need your reliever more than 3x a week you need it (but as Twinkly said, probably get a review). And if you or anyone else reading need more than the 'maximum' dose on the label then you need it (but should definitely be getting help at that point!) But if having an attack don't think oh I have already had x puffs today, I can't do 10 puffs through a spacer because it will take me over the maximum.

I know that wasn't what you were referring to Superzob, but I wanted to spell it out because I have seen a few people worried that a 'maximum' dose means it's dangerous to have more than that and thinking they should limit their use in an acute situation.

[Margaretindevon in reply to Lysistrata]

Thank yo! That was exactly what I was thinking! I am too law abiding for my own good!!!

[Lysistrata Administrator Community Ambassador in reply to Margaretindevon]

I actually think this whole area is often explained very poorly to patients, and often misunderstood by medical staff. I think they need to be much clearer about the difference between 'needing' and 'using' the reliever, and when to use it ie not waiting till you are as blue as the inhaler! I've heard of people never being told what reliever is for properly and when you should take it, so they get the impression it's some kind of emergency device like an epipen that you should almost never need or use, even if you're really symptomatic.

I also think medical staff need to understand and communicate that needing reliever but not using it does not magically mean you are better controlled, and you should not be avoiding use just so you can say you don't take it more than x times.

I'm not saying this is you, but I've seen a few examples of people being told they should just not take it so they can meet a target, and it doesn't matter how often they actually need to.

Not explaining the difference between 'needing to use' and 'actually using' also leaves a lot of people thinking it's like an overdose if you take more than that 'maximum', instead of the reality that it means very poor control and likely an attack coming up.

Sorry...off my soapbox lol.

[Margaretindevon in reply to Lysistrata]

Please….stay on that box…..you are perfectly right. It isn’t explained enough. When I was first diagnosed I was handed a blue and a brown inhaler, told to take one puff from each morning and night and sent on my way.

[CharlieLondon in reply to Lysistrata]

very good point. I am always fearful of taking my blue inhaler but in reality I probably need it most days although rarely take it. I will be explaining to the asthma clinic that I need my blue inhaler everyday to get my point across that i am uncontrolled.

[Superzob in reply to Lysistrata]

No problem - you raise an important issue

[Celbie]

Oh that is such a funny comment about wanting to stick around to teach the great grand kids how to wind up their parents! You are dead right...do everything you can, as life is too short to be annoyed by this post nasal drip issue.

If you figure out the solution.. we are all waiting here to hear about it!