Brief Answer:
Need to repeat Xray chest, treat wheezing and then workup for nasal bleed

Detailed Answer:
Hi! Welcome to health care magic!

I have tried to go through your past history and queries. You seem to be lost in quest of what to do next. I sincerely hope, few suggestions over this scenario work well for you.

First, you need to prioritise matters based on gravity of each problem. First this wheezing and difficulty breathing is concerned. Using albuterol alone may not be sufficient. Try to get to a pulmonologist and get a detailed evaluation with respiratory functions tests, and repeat the chest Xray and CT may also be needed as an year ago is too old, and problem has persisted since then or rather worsened. You also need to have blood screens for white blood count alongwith differential counts to rule out infective exacerbation of asthma or allergic triggers by evaluating type of leucocytosis.

The pulmonogist may like to add few other inhalers like ipratropium or corticosteroids inhalers along salbutamol for symtomatic relief. If any signs of infection are identified, you may be asked for an antibiotics course.

For bleeding and crusts, you need to have detailed ENT evaluation. You said local cause doesn't exist, ok, I agree but it would be appreciable to share details of the reasons or work ups which have convinced me to lead you believe it, as I would ba able to share more details to proceed for, if any local cause of bleeding is left to be worked out. Preferably a CT scan of Paranasal sinuses needs to be done and detailed examination for polyp or sinuses infections needs to be done with workup to assess or identify any bleeding vessel or focus of bleeding. Also get coagulation profile done to rule out any bleeding tendency leading to frequent mucosal bleeds. Keep nose moist with emolients like soda glycerine, liquid paraffin or vaseline and use steam inhalations in case of local irritations.

Even if it is coming from lower respiratory tract, it still can't be put in domain of atelactasis and left alone. It may need workup for pulmonary kocks or any signs of chronic inflammation or granulomas. A detailed vascultidies profile with ANA, ESR and XXXXXXX to rule systemic vascultis as these may present woth these. Discuss these with your doctor and proceed step wise to get rid of this chronic issue once and forever.

Meanwhile quit smoking as it is making you vulnerable to the worsening if symptoms and lung got fibrosed then already present asthma will become difficult to be handled ten years from now. I know I had been too emphasising but it is not to create any unnecessary panic except that since it has lasted for so much period and you are continously asking questions regarding that and not getting relief.

Wishing you a good health. Hope this has answered your query. If you have any more questions, feel free to ask. Keep me apprised through my profile and hope we can come up with something concluding to help you further. Regards.

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