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Questions Regarding Persistent Chest Infections

Feb 19, 2009

Dear Dr Robert,

Thanks for all your work.

I am 42 years old and since the age of 7 have had asthma and frequent chest infections. Sometimes up to 2 or 3 a year. I have also had years where mylungs were well behaved and caused no problems.

However, I believe I have had a constant chest infection since I sero-converted in Aug 2007.

My HIV physician says that because my CD4 is high (above 400) and my VL is low below 10,ooo and my percentages are good that this cannot be related to HIV infection.

My general physician has referred me to respiratory specialists who basically listen to my chest and tell me that nothing is wrong with me. Perhaps, they say, I am experienceing anxiety over my HIV diagnosis. They do not hear that it was concern over the state of my chest prompted me to get an HIV test in the first place. A sputum sample, proved normal apparently.

I am using copious amounts of asthma medication- both reliever (salbutamol) and preventative(budesonide/formoterol). I sometimes take a 100 doses of salbutamol in a 24 hour period. This gets me breathing almost normally. Although I am being admonished by my general physician for this, I believe I would end up in the emergency room if I didn't.

I can no longer exercise regularly and I sometimes get up in the morning have breakfast and return to bed to sleep solid for another 8 hours. I get so exhausted. I get hadaches and pains in my rips and back from coughing so much. I sweat easily during the day and night and I am getting infections like jock itch that will not respond to treatment.

The next thing on the cards is a broncoscophy which may take months yet to have done.

Can you offer me any advice or guidance? Are there questions I should be asking that I have not thought about? Any treatments you can think of other than the usual anti-biotocs?

I am a non smoker, I don't drink or drug. I am not yet on any HIV meds

Thanks for your time. And you have been a reassuring voice to me on many occasion.

Michael , London. UK

Response from Dr. Frascino

Hello Michael,

Asthma is a very changeable illness. Sometimes mild childhood asthma completely goes away around the time of puberty. Other times asthma can severely worsen in adulthood.

I would suggest you see an asthma specialist (pulmonologist or allergist). You need pulmonary function testing. You also need to be weaned back on your salbutamol. Your current doses are extremely dangerous. Overuse of those types of inhalers has been linked to sudden asthma deaths. You are at considerable risk!

Whether your increased symptoms are linked to your HIV disease, I can't say over the Internet, from the limited information provided. Whatever the cause, you need help weaning from your meds and also a full workup to check pulmonary function. Don't delay.

Good luck.

Dr. Bob

HIV Despite Condom Use?
Really need some help..

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