Severe asthma or yet again something else?

Question

Dear expert,
I suffer from severe asthma. Every three months I get a severe asthma attack. Even inbetween, I have permanent cough, much sputum and problems to breathe.
I have very many infections and every year at least two pneumonias. One could already speak about "permanent antibiotic therapy". Now Pseudomonas has been found in my sputum already several times. My physician said it would probably be a chronic colonizaton. What does this mean? I thought "chronic colonizations" would only occur in case of cystic fibrosis? Is Pseudomonas not a germ specific for CF?

My asthma medications are fluticason+salmeterol, montelukast, prednisolon 5 mg, aclidinium bromide.
My physician is of the opinion, I should do a CF test at a center. However, I am 32-years old, at that age no CF is diagnosed, isn't it?
Something has to be done, because the many infections weaken me and worsen the lung function all the time. Is it common, that asthma has such a severe course or should it really be something else?
I inhale daily salbutamol via a nebulizer and I can breathe better with this and can cough up the mucus.

Best regards,

Answer

Dear questioner,
in your mail you present as an asthma patient, describe an increased susceptibility for infections and several findings of Pseudomonas aeruginosa in your sputum. You ask several questions:
1. What does a chronic colonization with germs mean?
2. Does a chronic colonization with Pseudomonas aeruginosa only occur in case of CF?
3. Can CF be diagnosed also at adult age?
4. Can bronchial asthma have such a severe course?

ad 1: a chronic colonization with germs means, that a specific germ can be found repeatedly in the investigated material (here in the sputum).

ad 2: Pseudomonas aeruginosa (PA) is a frequently found germ in the airways of CF patients. About 60-80% of all adult CF patients are chronically colonized with PA. PA however does also occur in other illnesses, if it comes to structural changes in the lungs due to an illness like e.g. bronchiectasis, chronic bronchitis i.a.

ad 3: it can not be excluded, that in case of atypical courses the illness of CF can also be diagnosed at adult age. In order to exclude this diagnose, a so-called sweat test should be performed as a first step two times at a certified CF center. Dependent on the result further steps have to be taken.

ad 4: bronchial asthma can also show more severe courses. These are characterized by frequent acute infections, and by non-reversible narrowing of the bronchi, so that the asthma leads to a chronic obstructive lung disease. Chronic colonizations with germs can not be excluded hereby. Often it is however like this, that in case of bronchial asthma more severe phases of the illness occur temporarily with more frequent infections that are reversible via a respective anti-obstructive, mucolytic and antibiotic therapy.

We hope that the given information helps you to have a talk with your physician in order to find the best diagnostic and therapeutic way for you to improve your health status.

Best regards,
Yours
Dr. med. Christina Smaczny

07.02.2015