DD23 has Covid settling into her lungs. Any suggestions?

[Tap]

DD23 has had Covid for about a week. Most symptoms have been very mild cold symptoms, but I can hear it in her lungs when we talk on the phone. (She is in a different state). 

What can help her get the phlegm loosened up and out? She normally has severe asthma and uses high dose inhalers, along with her albuterol if needed. Her asthma is considered COPD level, so I really do mean severe complicated asthma. Due to this, she doesn't have the airway force to expel things like a typical person does.

She doesn't have a pulmonologist in that area to check in with. I usually fly her home, if she needs to see a specialist. Her pulmonologist at home, only sees people till 22, and we haven't settled her into a new one yet, because we were going to get her set up with an adult one in her own area. We thought her and her dh were getting relocated this spring (military) but just found out they are not. They are in Las Vegas if anyone knows a good pulmonologist in the area.

What we are already doing: She is using her Symbicort inhaler 5x2 puffs daily (doctor prescribed at this dose, it is called SMART therapy if anyone is interested). She works at her desk with a small humidifier running, but I also sent her a large one for the living room which will arrive Monday. I send her Mucinex and lozenges to keep her mouth moist and to thin the phlegm. She already drinks in excess of a gallon a day so the Mucinex should do its job. She doesn't usually use a peak flow meter, but I sent her one to monitor her lungs physical action of breathing. She has a pulse ox, and knows to alert me if it drops to 95. 

 

Any other ideas?  I know about doing chest thumping and I am looking for a video on that to send her. I am just getting concerned, that the sounds in her lungs is getting loud enough that I can hear it on the phone. She doesn't have a fever, or other obvious signs of infection (breath odor, lethargy worsening, pain on breathing etc), but I would like to prevent it from getting that bad as well! 

Covid from a distance with kids is horrible!! 

 

 

[Frances]

Is she sleeping on her stomach? Sorry I don’t have any more ideas, asthma here is not as severe. I certainly hope she feel better soon.

Edited January 15, 2022 by Frances

[Tap]

Just now, Frances said:

Is she sleeping on her stomach? Sorry I don’t have any more ideas, asthma here is not as severe. I certainly hope she feel better soon.

Good thought, I will find some information that and send it to her. (She has a scientific mind, so actual data helps her know theories are supported with evidence LOL)

[katilac]

Did you just send the Mucinex or does she already have it? Because it would be worth a delivery fee to get it to her today, imo. I say that it saved some of us from drowning when we had covid, lol. 

Might a breathing machine be better than the inhaler during covid? Or a mix? Can you ask her old pulmonologist for advice on this, even if she doesn't see him anymore? Or her current GP? If she could do albuterol in a breathing machine, that's going to break up the gunk more quickly ime. 

I feel for you, having her so far away. It's hard!

[Frances]

1 minute ago, katilac said:

Did you just send the Mucinex or does she already have it? Because it would be worth a delivery fee to get it to her today, imo. I say that it saved some of us from drowning when we had covid, lol. 

Might a breathing machine be better than the inhaler during covid? Or a mix? Can you ask her old pulmonologist for advice on this, even if she doesn't see him anymore? Or her current GP? If she could do albuterol in a breathing machine, that's going to break up the gunk more quickly ime. 

I feel for you, having her so far away. It's hard!

Our pediatrician used to advise this when things were really bad during a cold that had settled in the lungs. Use a nebulizer first to make sure they are really getting the full force of the treatment and then can go back to an inhaler when things start improving. They would often do a nebulizer treatment right at the doctor’s office and check his lungs afterwards in order to make sure nothing more was needed.

[katilac]

Can she call her insurance and ask for advice? As in, I don't have a pulmonologist locally and now I have covid, what can I do? 

Telehealth appointment? 

Fluvoxamine at a high dose is being used for covid, acting as an anti-inflammatory. It's safe and cheap, so might be easy to get a rx for. 

[prairiewindmomma]

Percussion therapy

active breathing: diaphragmic inhale/pursed lip exhale, candle blowing, etc.

sleeping prone

mucinex and Sudafed if she can handle it

honestly, she probably needs a telemed appointment at this point because she is complicated

[katilac]

Also, even if she isn't feverish or aching, she should take ibuprofen around the clock as an anti-inflammatory (unless she has a reason not to). 

[melmichigan]

I would switch to a nebulizer as well so I could divide out the albuterol PRN.

Percussion and if unable to get someone to do it then shower with massage shower heads a few times a day.

[katilac]

Just now, prairiewindmomma said:

 honestly, she probably needs a telemed appointment at this point because she is complicated

Yes, I would want someone to lay eyes on her and consider all of the medication as a whole. 

[TCB]

It sounds like she needs to seek an appointment with a Dr in case she is needing steroids. She may also still be in the window of opportunity for monoclonals or Paxlovid. If she hasn’t seen someone yet, I would strongly recommend it.

[Tap]

6 minutes ago, katilac said:

Did you just send the Mucinex or does she already have it? Because it would be worth a delivery fee to get it to her today, imo. I say that it saved some of us from drowning when we had covid, lol. 

Might a breathing machine be better than the inhaler during covid? Or a mix? Can you ask her old pulmonologist for advice on this, even if she doesn't see him anymore? Or her current GP? If she could do albuterol in a breathing machine, that's going to break up the gunk more quickly ime. 

I feel for you, having her so far away. It's hard!

She got the Mucinex yesterday and took it even before she called to say it arrived. LOL Her pulmonologist didn't prescribe a nebulizer to her, as he didn't think it would be helpful in her case on a daily basis. (He had good reasons at the time, I just don't remember them) That may be different now with COVID tho, interesting thought. I can look into getting her one, but it will take a few days. 

The last time I reached out to her pulmonologist, his staff intercepted the message and said to contact a local adult pulmonologist in her area. They are absolutely an amazing practice, so I think they have to get firm on us patients who would like to linger with him instead of moving on. 🙂 

Her GP will do pretty much anything I ask. But I will have to figure out where to get one, that can be delivered to a military base in a timely manner, to an active COVID patient. 

 

[Tap]

18 minutes ago, Frances said:

Our pediatrician used to advise this when things were really bad during a cold that had settled in the lungs. Use a nebulizer first to make sure they are really getting the full force of the treatment and then can go back to an inhaler when things start improving. They would often do a nebulizer treatment right at the doctor’s office and check his lungs afterwards in order to make sure nothing more was needed.

This reminds me of why she doesn't typically use the nebulizer. With SMART therapy, you can use albuterol alone, but the idea is that you use Symbicort instead when the patient feels restricted breathing. That is why she takes it up to 5 times a day; twice daily no matter what and then up to 3 additional times. She gets not only the steroid dose, but the long acting beta agonist (formeterol) to open up the passageways.  This works wayyyyy better than anything else she tried. 

She can use albuterol, if she is exercising or is expecting to need it. But even that, is at wicked high doses. 2 puffs when dressing, then 15 minutes later 2 more puffs, then every 30 minutes of exercise up to 8 puffs. 

Even with albuterol and Smart therapy, she still doesn't pass pft tests. 😞 

Edited January 15, 2022 by Tap

[mom2samlibby]

I had covid in December. The doctor prescribed an antibiotic and a steroid.  

[kbutton]

11 minutes ago, TCB said:

It sounds like she needs to seek an appointment with a Dr in case she is needing steroids. She may also still be in the window of opportunity for monoclonals or Paxlovid. If she hasn’t seen someone yet, I would strongly recommend it.

This.

I also think a nebulizer treatment would potentially be more effective. When I used to have certain kinds of flares, nebulizer was the only thing that helped. I would be able to hear bubbles in my lungs breaking up after a nebulizer (when I opened my mouth, it sounded like Rice Krispies getting wet), but after my inhaler? Nothing. It did nothing. And honestly, I did back to back nebulized albuterol to get those results because I know they often do back to back in the ER, and it was helping so, so dramatically to use the neb. (I don't wheeze, so at that time, I could get compromised without knowing it. I have since learned different cues + went GF, so it doesn't happen anymore.)

A nebulizer treatment at urgent care or ER usually has steroids plus albuterol from what I understand. I don't know if the steroid is something like pulmicort, or if it's a different one, but if it's usually the same as a control inhaler, she could nebulize both the rescue and control meds at home for now if she got the means to do so. 

[Lisa]

Have her sleep on her stomach. I really helps with covid.

[Fritz]

54 minutes ago, Tap said:

DD23 has had Covid for about a week. Most symptoms have been very mild cold symptoms, but I can hear it in her lungs when we talk on the phone. (She is in a different state). 

What can help her get the phlegm loosened up and out? She normally has severe asthma and uses high dose inhalers, along with her albuterol if needed. Her asthma is considered COPD level, so I really do mean severe complicated asthma. Due to this, she doesn't have the airway force to expel things like a typical person does.

She doesn't have a pulmonologist in that area to check in with. I usually fly her home, if she needs to see a specialist. Her pulmonologist at home, only sees people till 22, and we haven't settled her into a new one yet, because we were going to get her set up with an adult one in her own area. We thought her and her dh were getting relocated this spring (military) but just found out they are not. They are in Las Vegas if anyone knows a good pulmonologist in the area.

What we are already doing: She is using her Symbicort inhaler 5x2 puffs daily (doctor prescribed at this dose, it is called SMART therapy if anyone is interested). She works at her desk with a small humidifier running, but I also sent her a large one for the living room which will arrive Monday. I send her Mucinex and lozenges to keep her mouth moist and to thin the phlegm. She already drinks in excess of a gallon a day so the Mucinex should do its job. She doesn't usually use a peak flow meter, but I sent her one to monitor her lungs physical action of breathing. She has a pulse ox, and knows to alert me if it drops to 95. 

 

Any other ideas?  I know about doing chest thumping and I am looking for a video on that to send her. I am just getting concerned, that the sounds in her lungs is getting loud enough that I can hear it on the phone. She doesn't have a fever, or other obvious signs of infection (breath odor, lethargy worsening, pain on breathing etc), but I would like to prevent it from getting that bad as well! 

Covid from a distance with kids is horrible!! 

 

 

If you can hear it when speaking to her on the phone she probably needs to be seen by MD (at least a telehealth visit). Sounds like nebulizer treatments and steroids might be needed. 

[fairfarmhand]

Does she have a nebulizer to use?

My ds got really bad (not covid, just a nasty virus) last December and the nebulizer made a big difference.

[plansrme]

N-Acetyl-Cysteine? It is used by cystic fibrosis patients to loosen phlegm. We kept it on hand for bronchitis back when I had a kid who got bronchitis regularly. We all felt that it helped.

[chocolate-chip chooky]

Here's a simple trick to induce a good deep cough:

Take a deep breath and then blow out for as long as you can. When you think you really need to stop, keep blowing for a few more seconds. You might be kind of shaking with the effort to keep blowing out for that last few seconds.

Deep, clearing coughs will follow.

This was taught to us by a respiratory physio.

 

[matrips]

I’m not very familiar with it, but Nigella Sativa has some studies about being used for asthma, as well as covid.  Would Vicks help at all?  Otherwise, everyone had good suggestions.

[Drama Llama]

I wonder about an antibiotic. You want to keep stuff from growing in the phlegm, and an infection from developing. 

We did percussive therapy with a couple different machines, but that might not be needed.

I agree she needs to be seen.  Does she have access to a military hospital?  I thought their system was designed to handle people with frequent moves, so they might be able to help quickly.  

[Tap]

So, interesting.  The peak flow meter arrived. She was able to blow almost to the normal line. She had used her inhaler a little before it arrived. This is Great for her!!! But her husband (who also has COVID) blew a mid-range number!! The both had pulse ox number in the 95-100 range. I can still hear her lungs being junky, but at least this is a good sign she can get rid of the phlegm.

Her husband thought he was feeling better (he is on day 11), but used her albuterol and said it helped him breathe better, so we now need to keep an eye on both of them. 

They are both going to try the breathing exercises. 

I talked to them for about 30 minutes. During that time, I told her I could hear her lungs and she said she could feel them too. They are going to get up and going for the day, and then report back. They are going for a short walk outside and a quick commisary run for supplies. (They are past quarantine rules and will double mask anyways).  Her husband says she looks worse today. He lured her out of bed with a cozy little set up♥️ (drink, blanket on the couch, dog, soup, meds etc) but she hasn't moved much beyond that. 

I mentioned a telemed visit and she seemed reluctant. She knows  they won't be able to actually hear her lungs and may try to treat her with medication, without actually having eyes on her.  I can hear her lungs, because I know her voice, they won't. 

 

[Tap]

12 minutes ago, Baseballandhockey said:

I wonder about an antibiotic. You want to keep stuff from growing in the phlegm, and an infection from developing. 

We did percussive therapy with a couple different machines, but that might not be needed.

I agree she needs to be seen.  Does she have access to a military hospital?  I thought their system was designed to handle people with frequent moves, so they might be able to help quickly.  

The only option on base, is the base ED (no urgent care). She can go to a private hospital (I keep her on my insurance, just incase she wants to go off base) but the wait times are attrocious due to capacity. One of them will call me for advice, if she gets too bad. They have a bit of PTSD from going to the ED, and the ED blowing her off. Only to call with the results of her tests and asking her to return to be admitted. 😕 There have been a few visits to the base hospital that were less than stellar. She appreciates the care, but of anyone, I am sure you completely understand the PTSD feeling of going to a hospital. ♥️

[Tap]

25 minutes ago, matrips said:

I’m not very familiar with it, but Nigella Sativa has some studies about being used for asthma, as well as covid.  Would Vicks help at all?  Otherwise, everyone had good suggestions.

Vicks is a good idea but she is already using eucalyptus and peppermint in her humidifier.

[thewellerman]

Tricare dependents can also utilize any off base urgent care.  There shouldn't be any fees, unless they are Tricare standard, then the typical fees for that would still apply. 

[Tap]

18 minutes ago, thewellerman said:

Tricare dependents can also utilize any off base urgent care.  There shouldn't be any fees, unless they are Tricare standard, then the typical fees for that would still apply. 

That is good to know!  She does have the Tricare that she can use off base but I doubt they will go to urgent care. LOL She has been sick for 10 years (chronic health issues) and she is really tough and downplays her symptoms. She is the type to put off going to the doctor, until it is really bad (hence getting admitted a few times LOL). I usually have to tell her husband to take her, and he will listen to me. 🙃

[DreamerGirl]

No helpful suggestions.

Just hugs for you and her and healing thoughts. 

[Drama Llama]

30 minutes ago, Tap said:

I am sure you completely understand the PTSD feeling of going to a hospital. ♥️

I do 100%.  Unfortunately, I also understand the danger of delaying medical care.  

 

[Melissa Louise]

Chest percussion, fluids, movement. 

Post. Covid, appts with a respiratory physiotherapist, if possible. 

 

[Melissa Louise]

Ok, the worst thing she can do is snuggle down on the sofa all day.

If she is unwell enough not to be able to do more than that, she needs a medical appt. Either a/bs or steroids or both needed. 

Can her husband google chest percussion and do it for her? 

[Drama Llama]

I would go to the ER with the best pulmonary reputation.  

[kristin0713]

1 hour ago, plansrme said:

N-Acetyl-Cysteine? It is used by cystic fibrosis patients to loosen phlegm. We kept it on hand for bronchitis back when I had a kid who got bronchitis regularly. We all felt that it helped.

NAC is really good. I totally think it helped prevent this from affecting my lungs. I asked DH's neurologist if he could take it (we have to clear everything with him) and he said yes there is no harm in taking it and it may really help. He sent me a study from Greece where it had promising results for covid. 

[Pippen]

1 hour ago, Tap said:

So, interesting.  The peak flow meter arrived. She was able to blow almost to the normal line. She had used her inhaler a little before it arrived. This is Great for her!!! But her husband (who also has COVID) blew a mid-range number!! The both had pulse ox number in the 95-100 range. I can still hear her lungs being junky, but at least this is a good sign she can get rid of the phlegm.

Her husband thought he was feeling better (he is on day 11), but used her albuterol and said it helped him breathe better, so we now need to keep an eye on both of them. 

They are both going to try the breathing exercises. 

I talked to them for about 30 minutes. During that time, I told her I could hear her lungs and she said she could feel them too. They are going to get up and going for the day, and then report back. They are going for a short walk outside and a quick commisary run for supplies. (They are past quarantine rules and will double mask anyways).  Her husband says she looks worse today. He lured her out of bed with a cozy little set up♥️ (drink, blanket on the couch, dog, soup, meds etc) but she hasn't moved much beyond that. 

I mentioned a telemed visit and she seemed reluctant. She knows  they won't be able to actually hear her lungs and may try to treat her with medication, without actually having eyes on her.  I can hear her lungs, because I know her voice, they won't. 

 

Does she normally use a peak flow meter? I ask because my green zone is atypical. I'd feel like I was having problems and when I'd report my numbers they would say no problem--you're in the green. This continued until my allergist finally redefined my normal zone.

[Tap]

Just now, Pippen said:

Does she normally use a peak flow meter? I ask because my green zone is atypical. I'd feel like I was having problems and when I'd report my numbers they would say no problem--you're in the green. This continued until my allergist finally redefined my normal zone.

No. But what I want her to watch, is for consistent declining numbers.

Her pulmonologist, didn't want her to worry about a peak flow meter for her regular asthma. He wanted her to go by how she felt and her activity levels. ie If she felt fine on either end, but was breathless by walking up stairs....that was an 'activity level' concern.  He knows that DD23 tends to minimize her health needs due to multiple chronic illnesses. She tends to go by how she feels over the course of a day or week, not individual moments. So her reports on things like her asthma can be a bit skewed. LOL

[Carol in Cal.]

What strength mucinex does she have?  I find that only the 600 or 1200 strengths work for me at all.  

I agree that she should try to walk around, but gently, as often as possible, to keep her lungs clearing.  

And if she has a Zpack around, start taking it.  It helps with inflammation as well as being an antibiotic.  The last thing she needs right now is to get a lung infection from the phlegm.  

Zinc under the tongue every two hours is an immune booster.  

[matrips]

2 hours ago, kristin0713 said:

NAC is really good. I totally think it helped prevent this from affecting my lungs. I asked DH's neurologist if he could take it (we have to clear everything with him) and he said yes there is no harm in taking it and it may really help. He sent me a study from Greece where it had promising results for covid. 

How much NAC did you take?  We have 600mg pills, but teen Ds has covid, and wondering if to increase dosage.

[arnold]

Have her blow up balloons….it expands the lungs and gets the air moving. 

[kristin0713]

13 minutes ago, matrips said:

How much NAC did you take?  We have 600mg pills, but teen Ds has covid, and wondering if to increase dosage.

I took between 1200-1800 a day

[matrips]

8 minutes ago, kristin0713 said:

I took between 1200-1800 a day

Thanks.  

[katilac]

Have her search for "at-home urgent care" or "house call doctor" in her area. Eyes on her and medical equipment without going in. 

My nephew used a service like this when he had covid and wasn't sure if he needed to go back to the ER. They checked him out, said he didn't need to go in, but told him very specifically when he should go in. 

My mom had the EMTs out for the same reason. 

[Tap]

1 hour ago, Carol in Cal. said:

What strength mucinex does she have?  I find that only the 600 or 1200 strengths work for me at all.  

I agree that she should try to walk around, but gently, as often as possible, to keep her lungs clearing.  

And if she has a Zpack around, start taking it.  It helps with inflammation as well as being an antibiotic.  The last thing she needs right now is to get a lung infection from the phlegm.  

Zinc under the tongue every two hours is an immune booster.  

She and her dh are taking 1200mg twice daily. I agree about her moving around. I know they are both getting a bit antsy from laying around. He husband spent the morning cleaning house, so I know he is up and about. She did text to say they didn't make it to the store, but hopefully were going for a walk outside. 

[GracieJane]

Not to scare you, but my (decently healthy) dad got Covid a month ago and didn’t see a doctor in person for a week or two. In that time his lungs were getting worse and eventually he was rushed to the ER and started on steroids and antibiotics. The doctors said that he should have come in much earlier, because the medication takes time to effect change and Covid attacks lung tissue at an accelerated speed as time and pneumonia set in. Now (a month later) he is still in the hospital on oxygen. I never, ever go to the doctor or have any health issues. But now I tell everyone I know it is absolutely not worth it to delay a medical visit for Covid. It’s just a different, brand-new virus that is totally foreign to our bodies and it is worth a few hours in the ER to get medicine.

Edited January 16, 2022 by GracieJane

[KSera]

59 minutes ago, kristin0713 said:

I took between 1200-1800 a day

@matripsDo be mindful if he reports stomach pain after that dose. My kid who takes it gets bad pains if the dose is too high.  

[Tap]

57 minutes ago, GracieJane said:

Not to scare you, but my (decently healthy) dad got Covid a month ago and didn’t see a doctor in person for a week or two. In that time his lungs were getting worse and eventually he was rushed to the ER and started on steroids and antibiotics. The doctors said that he should have come in much earlier, because the medication takes time to effect change and Covid attacks lung tissue at an accelerated speed as time and pneumonia set in. Now (a month later) he is still in the hospital on oxygen. I never, ever go to the doctor or have any health issues. But now I tell everyone I know it is absolutely not worth it to delay a medical visit for Covid. It’s just a different, brand-new virus that is totally foreign to our bodies and it is worth a few hours in the ER to get medicine.

I agree! I wish she was home. I would just schedule a visit with the doctor and she would go.  It is the worst time to try to talk her into going in, when she isn't feeling well. It is just how she works. I will give her a couple of days and then, start calling on Tuesday to see if I can get her in for a visit somewhere with a pulmonologist. 

[TCB]

1 hour ago, Tap said:

I agree! I wish she was home. I would just schedule a visit with the doctor and she would go.  It is the worst time to try to talk her into going in, when she isn't feeling well. It is just how she works. I will give her a couple of days and then, start calling on Tuesday to see if I can get her in for a visit somewhere with a pulmonologist. 

If she is going to get MAB therapy it needs to be initiated before oxygen levels fall. Honestly CoVid is different than other things. I would not wait around to get seen if I was worried it was affecting my lungs.

[staceyobu]

It sounds like she may still be in the window for monoclonal antibodies. It may be difficult to get them because only one brand still works against omicron and this brand was previously only about 10% of the market. Sotromivab is the only one that works against omicron. Do not let them give her regeneron (regen-cov) or bamlanivimab. (How places are still administering monoclonals that don't work is baffling to me.) It would be worth the hunt to get monoclonals on board. They are given free of charge via IV.

You have to get monoclonals while you are still relatively healthy. Once you need oxygen, you are no longer eligible. Don't waste time waiting to see where this heads. 

[Tap]

21 minutes ago, staceyobu said:

It sounds like she may still be in the window for monoclonal antibodies. It may be difficult to get them because only one brand still works against omicron and this brand was previously only about 10% of the market. Sotromivab is the only one that works against omicron. Do not let them give her regeneron (regen-cov) or bamlanivimab. (How places are still administering monoclonals that don't work is baffling to me.) It would be worth the hunt to get monoclonals on board. They are given free of charge via IV.

You have to get monoclonals while you are still relatively healthy. Once you need oxygen, you are no longer eligible. Don't waste time waiting to see where this heads. 

Any idea on how to even get started looking for it? 

[kristin0713]

8 hours ago, KSera said:

@matripsDo be mindful if he reports stomach pain after that dose. My kid who takes it gets bad pains if the dose is too high.  

I should have been more specific - I took 600mg 2-3 times during the day. 

[Pippen]

9 hours ago, Tap said:

I agree! I wish she was home. I would just schedule a visit with the doctor and she would go.  It is the worst time to try to talk her into going in, when she isn't feeling well. It is just how she works. I will give her a couple of days and then, start calling on Tuesday to see if I can get her in for a visit somewhere with a pulmonologist. 

I would think the fastest way to get an appointment with a a pulmonologist would be through a local referring doctor.