Brief Answer:
Need another antibiotic

Detailed Answer:
Hello -

Some strains of pneumonia-causing bacteria are resistant to amoxicillin, and if you had a chest X-ray consistent with pneumonia and are still having a fever and discolored respiratory mucus after 7 days without much improvement, then you probably are not fully treated.

I recommend you go to the urgent car or ER and they will likely give you a prescription for azithromycin which is good for pneumonia. I would not wait further. This could get worse.

I don't think the Vicks or heating pad will do the trick at this point. They won't hurt if they make you more comfortable. And also drink a lot of water to help thin the secretions. But you likely need a different antibiotic.

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Brief Answer:
Thoughts on this

Detailed Answer:
I have asthma too and know what it can be like when an infection causes an exacerbation. I am very glad you went in. I am quite conservative about giving antibiotics, but it is warranted here.

Regarding over the counter meds and humidifiers and vaporizers, here are my thoughts:
1. Guaifenesin (Mucinex) would still be a good idea. It is a mucolytic - it draws water to the mucus to thin it out and allow it to pass more easily. For it to work you have to drink a lot of water.
2. Decongestant (pseudoephedrine) is questionable as to whether to use when you have an asthma exacerbation. It can possibly dry things up which, if it causes mucus trapping in the airways, can make things worse. So it sometimes helps but should only be used with caution.
3. Steroids such as you were given can be beneficial for decreasing the inflammation. I see that you were already prescribed some. Are you done with them now? If so, are you now using your Symbicort?
4. Do you have a lot of post nasal drainage? If you are, and you are done with the oral steroids, a nasal steroid such as Flonase can help. This is sold without prescription.
5. If your home is very dry a vaporizer might help. Problem with vaporizers and humidifiers is that once used, it's hard to get them mold/fungus free. I used to use them in the past but since I've learned about the mold problem with them I no longer do. Still, if your home is very dry and you find that moisture helps, you can try a vaporizer. Or sit in the bathroom with the door closed and the hot shower on for a little while. I personally find humidity to make asthma more uncomfortable some people find it helpful. So I will defer recommendation on this to your own past experience.

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Brief Answer:
Thoughts on this

Detailed Answer:
Hi XXXXXXX

I am so sorry, and I feel for you! I too struggle with these things. I am a family practice physician, not an allergist, but I can share with you what I've learned from allergists, reading on the subject, and personal experience. Much of this you may already know and do:

- Bedroom should be kept as allergen free as possible since you spend many hours there sleeping. Dust mite covers, wash bedding in hot water once a week if possible, fragrance free detergent, no fabric softener, no (antistatic) dryer sheets in the dryer. Don't hang wash outside to dry. No windows open. No carpets. Wash drapes, if you have them, frequently. Have someone dust weekly. Minimum of things in the bedroom (such as books). And most importantly, no pets in the bedroom. Even if you have been tested and no known allergies to pets, they should not be in the bedroom. I get my pillow and mattress barrier covers from Lifekind.

- Cosmetics: All fragrance free.

- No smoking of course.

- Supplements: Vitamin C helps some people.

- Infection precautions: Wash hands thoroughly every time you come into the house and have others do the same. Don't touch eyes or nose with your hands. The latter I was taught when I was a medical student doing hospital pediatric rotation.

- Vacuuming: Central vac, and have someone else do the vacuuming if you can.

- We have a Merv 13 five inch wide filter on our furnace and an Aprilaire air exchanger. We use a UV light on the furnace in spring and summer. We keep our windows closed except for a period of time in summer. We have a dehumidifier running constantly in the basement. I had major problems after a mouse infestation in our attic. Had mouse proofing service come which used warfarin bait stations and had us cut back overhanging tree branches and fill in very small gap under garage door. The mice leave a highly allergenic urine protein (the males spray this to mark) which I have not found the answer to denaturing to render it unproblematic.

- Elimination diets to see if certain foods increase your symptoms (dairy, etc). It can take a few weeks of elimination to see.

- Change clothes when you come in the house so that you aren't brining allergens in with you.

- Like you, I have had problems with room size air cleaners. They usually give off other smells probably from the components inside.

- No fire place smoke.

- Fan on high over gas cooking range and oven when in use, if you have gas.

- Nothing with fragrances or scents in the house.

- Nasal saline rinses (nettipot or Simply Saline ready made) whenever coming in from anywhere you have been exposed to allergens.

- Antihistamines may need to be used in higher dosages than specified. For example, Zyrtec (cetirizine) may need to be used in double or triple dosages but I will defer to your allergist on what would be right for you.

- Nasal steroids work for some people to keep the mucus production down.

- Keep piles of papers and things that can collect dust to a minimum.

- I use Advair twice a day (like Symbicort), Incruse inhaler (an anticholinergic inhaler), Zyrtec 25 mg/day. I did not get benefit from nasal inhalers but many people do.

Very frustrating. I understand this.

I don't know what to tell you about the wheezing after coughing up the mucus plugs except that this may be temporary bronchospasm from forceful coughing. But it is of course better to cough up the infected material.

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