Chest infection confusion

[floating_]

Hey everyone.

So this has happened twice now with similar sets of symptoms.

Recent symptoms:

Basically severely reduced peak flow (150 during the attacks, max is 470, about 250/280 now, so I'm well into amber still), been in and out of hospital the last few days with asthma attacks, increased work of breathing even at rest when I'm not doing anything, green gunk being coughed up, wheezing and crackles on my lungs when being listened to, coughing so much I puke, fevers, vomiting/diarrhoea (these two seem to have stopped, aside from my normal on average once a day vomiting), constantly waking up in the night, etc.

On the first night, they said my bloods were perfect, chalked the asthma attack up to the low temperatures and some other stressors. No crackles here, just wheezing (and initially silent chest/severely reduced air entry). And specifically that there was no infection, he made that clear, I asked!

Anyway, on the second A&E Visit I was given IV antibiotics and some oral ones to take at home. This was because I had crackles in my lungs among other things (chest xray, bloods, colour of sputum, how I needed oxygen, etcetc.). This day I had bloods show infection. Also had a chest xray and was told I have "mild fibrotic changes" (have asked my local Asthma nurse about it, she's gonna speak to local respiratory doctor).

Third time the doctor was quite combative and was like why are you on antibiotics, you have no reason to be until I was actually able explain everything then she rescinded her view point and agreed that I should continue the antibiotics and that she doesn't want this to turn into pneumonia or sepsis.

I just dont understand how they can have such differing view points all within literally 3 days??? Has this happened to anyone else? This has happened to me before as well. Haha.

I'm a Severe/Brittle Asthmatic. I'm on Xolair (technically for Urticaria but the dose would be the same for Asthma my tertiary care Asthma nurse said, and its working really well for me!). Also on a lot of antihistamines, Montelukast, Spiriva Respimat, Relvar Ellipta, Ventolin (inhalers, nebuliser), Carbocisteine. Finally, I am on replacement 5mg Prednisolone (for adrenal insufficiency) rather than therapeutic doses, was on 10mg for a while with higher doses for longer before that. Although right now I'm on 40mg Pred. (and the Antibiotics, Coamoxiclav).

Just really feeling ill at the moment and this confusion is not helping. But at least I'm not in hospital again tonight!

[MindfulBreathing]

Hiya, for many years I lived in Vienna, and there the general consensus is that if the sputum is green, there is a bacterial infection, for which you need antibiotics until after it's cleared up. Here in the UK, it appears that doctors have never heard of this guideline, but it served me well for many years. Guessing you're on steroids?

[floating_ in reply to MindfulBreathing]

Yeah, that's why she changed her mind, after initially insisting it was purely viral. She then went to look at bloods and said that there is an infection so I am staying on the antibiotics anyway (and my increased dose of steroids, to 40mg from 5mg).

Technically meant to go back down to 5mg of Prednisolone tomorrow, but still feeling rough, so might just wait a few days, maybe 'til Monday, then go back down, perhaps with a taper. Have increased my Carbocisteine as well to help.

[MindfulBreathing in reply to floating_]

Good luck, hope you get well soon 😊

[Lysistrata Administrator Community Ambassador in reply to MindfulBreathing]

Green phlegm means you have an infection, but by itself, the colour doesn't automatically mean it's bacterial and needs antibiotics. All it shows is that the body is fighting *something*. So doctors shouldn't be using that as a guide for antibiotic prescription. Doctors are not perfect on this - I used to have them try to give me antibiotics with zero evidence of infection as a 'just in case' because I was asthmatic - I learned to ask why and refuse them if they said they hadn't actually found any evidence of infection. Obviously in Floating's case they have plenty of other evidence to support there being a bacterial infection.

Floating, unfortunately I have found they often do have very different viewpoints! I'm glad to hear the third doctor changed her mind when she was told - especially given we are always being told to finish a course of antibiotics even if you feel better, to reduce resistance.

As a side note I often find that my asthma can be the first sign of an infection - they can be sneaky, and I have had some where I never got the typical signs of it, just showed on X ray etc when I went in for asthma. They have also tried to tell me it isn't an asthma attack because I present atypically. Even when they acknowledge I have an infection and acknowledge that I have asthma and that asthma is often triggered by infections, and that my 'asthma' symptoms are responding to asthma treatments.

Hope it goes soon!

[Itswonderful in reply to MindfulBreathing]

this is how it used to be here until the new trend which is to say that everything is a virus. Truth is, no one can be sure without a sample being sent to the lab so I think it has been part of the umbrella call from above to reduce antibiotic prescribing because of fears of resistant bugs. But recently on tbe news I heard a medical person calling for antibiotic prescribing to be increased over winter months because of the numbers of people ending up with severe bacterial infections that put them in hospital. And we all know what’s happening with hospitals now.

[Spikedog66]

I really need to ask might think I'm crazy. Did they do a covid test? You are describing everything I felt with covid. Clear test after a week but a lot of what you've said went on for several weeks. No hospital though. Still have a poor chest and nausea.

[floating_ in reply to Spikedog66]

Oh man, I'm so sorry! What have the doctors said? This stuff is awful.

I had a negative COVID test, yeah, so I don't think it's that. But I'll keep an eye on it anyway.

[Spikedog66 in reply to floating_]

I had 3 negative tests before a positive. It would be too late the test would be negative for you. It was just a thought. I hope you feel better soon x

[floating_ in reply to Spikedog66]

The thing is if it was COVID I'd likely be in hospital due to immune system issues, so I'm still not sure it would be that, but I'll keep it in mind. Thank you!

(Plus if it was COVID, maybe my immune system isn't as useless as they think it is. Haha!)