Asthma attacks/congestion/coughing after starting CPAP

Prior to starting using CPAP, I had never had an asthma attack. I would sometimes wheeze a little after eating a food that I know does this to me: wine, beer, donuts - but that was as far as it went. I started treatment for mild sleep apnea the first week of December 2013. My sleep study showed about 20/hour and the prescribed titration is 11. I have a Resmed S9 Autoset with climate hose and humidifier. As I am a mouth breather with facial hair, I spent the first week or so finding a mask that would work for me. The machine controlled my apneas. But, then the problems started.
I began to get coughing attacks and chest congestion. Never nasal congestion, just chest. I tried the machine with autoset with a small range of 10.5-13 and it worked fine in controlling my apneas. Always below 5, sometimes below 1. I subsequently went back to CPAP mode at 11 as that seemed to work for me. However, using any exhale pressure relief triggered central apneas so I stopped using this feature. So, the CPAP therapy was doing its job. But, I was not doing well at all. The 3rd week in December I had to go to the clinic because I couldn't catch my breath during a coughing spell. They found I was extremely clogged up "tight" and gave me a nebulizer treatment (which helped), a steroid shot in the butt, advised me to take Musinex DM, and use my inhaler as needed. Also, to see my doctor asap. On Jan 2, I went to my pulmonary doctor. He prescribed antibiotics, Prednisone, another steroid shot, my own nebulizer and refills. This temporarily helped me for a few days and I thought I was getting over it. But, I was wrong. A week later I was back in the clinic with shortness of breath/chest congestion/coughing. Was given yet another steroid shot in the butt and advised to see my doctor again asap. The next morning Jan 27th, I saw my pulmonary doctor again. We spent a lot of time talking over the sequence of events, what other medications I'm taking, and came up with a plan of action. One of my medications is Lisinopril, which he says sometimes causes problems with CPAP. He prescribed some additional medication for asthma - Montelukast - as well as a steroid nasal spray, along with cough syrup - and another steroid shot. He didn't want me to stop Lisinopril until determining the results of this new medication. Nor did he want me to stop using the CPAP machine or switch to another type quite yet. I've been taking the medication for the past 4 days and I'm much better. Coughing very little, congestion getting less every day, coughing is getting productive clearing out some of the gunk. So, I'm somewhat encouraged. But I also worry where this is leading. I don't like being dependent on these asthma drugs. I just might give up the CPAP therapy rather than take these drugs.
My own thoughts are that I'm extremely sensitive to the CPAP machine and to any changes to it. I have thought of buying another type of machine that would be easier on me. Money is not really an obstacle for me, my lungs are my priority.
After reading what I've been through, do you think another type of machine would/could benefit me? I've tried many settings of temp/humidity and the best seems to be the default 80degrees/80% for the S9. Any other thoughts or suggestions?

I am a severe asthmatic, have had asthma since I was a baby. I think CPAP helps me maintain control, and has for the past 14 years. Lisniproil is a drug most pulmonary specialists will tell you NOT to take if you have asthma or asthma like symptoms. I think you might want to discuss this again with your doctor. I had a family doctor who once put me on several different blood pressure meds (lisniproil was one), I coughed constantly and kept my inhaler in my hand most of the time. My pulmonary doctor (who I see twice a year) had a fit. Said most family doctors don't know or pay attention to BP drugs that trigger asthma.

Just my thoughts for you.
Jen

I caution against abandoning your CPAP therapy because of this, understandably, frustrating roadblock. Untreated apnea can cause irreparable harm to your heart, and other internal organs, due to oxygen deprivation.

Hang in there and continue to reach out for support!

It could be just a coincidence that you had an asthma exacerbation at around the time you started CPAP. There's this little upper respiratory virus (barely noticeable) going around that causes the most mild cold, but if you have asthma WHAMMO! Asthmatic bronchitis! I just got over that nasty little bug.

It could be the isoprinil, you'll have to work that out with your doctor. But it's a common side effect of that medication.

It could be that you need to adjust the humidity of your machine up or down to find the right setting that works with your lungs. My usual setting is about 2, but when I have asthma issues like the aforementioned bronchitis I crank it up to 5 and get wonderful nighttime relief of my asthma symptoms as long as I'm wearing the mask. But for some, too much humidity can cause symptoms, while others need more humidity. You need to slowly and carefully adjust and evaluate the humidity.

It could be an allergy to some material in the masks triggering your asthma. I let new masks air out for several days before use and then wash them well, to get rid of all the outgassing from the plastics used.

Sometimes a BiPAP to give more pressure relief on the exhale helps asthmatics. I do fine on regular CPAP, personally, despite pretty severe asthma.

CPAP can really be your friend with asthma, so it's worth finding the solution. As you can see, there are many confounding variables. You'll have to eliminate each in turn.

Another asthmatic here who had problems with lisinopril.

Thank you for your comments and suggestions. I'm going to talk to my primary doctor about substituting or eliminating Lisinopril. My pulmonary doctor mentioned that even some of the substitutes can also cause coughing, so is there a replacement that people here have had success with?
Thanks again for your help.

Bob

I was switched from Lisonopril to Losartan, after years of coughing and asking doctors why. I was having problems with reflux and asthma because of it. It made all the difference. I think Losartan costs a little more, and maybe that's why doctors are so hesitant to switch, but it costs much more to treat all the problems caused by that blasted cough!

You have thoroughly rinsed out, off all the plastic stuff associated with your VPAP? Nothing growing in the humidifier tank? You are using distilled Water? I keep mine in the fridge to make sure nothing starts growing in it while waiting for its turn in the humidifier tank.

Anything else new in your environment?

Now to what I really suspect. I used to have a lot of GERD. I believe I got over it by several things. First is giving up NSAID's. Giving up all Diary. Then my sleep doc suggested that part of what caused my Aerophagia was that the valve at the top of my stomach had been over time, destroyed by the sump pump effect of my gasping for air while I was asleep. That is the pressure of the xPAP was getting into my stomach because of the bad valve at the top of the stomach. Then a year or so there I went through a bunch MRSA skin infections, for which I took an Antibiotic, (which also killed the bacteria in my stomach). To which I attribute this story, some years ago a doc also prescribed an antibiotic to me, saying at the time, while he wrote one reason for Medicare (which was also truthful and valid), it would to get rid of the extra bacteria in my stomach, which in his experience would improve my stomach problems (that was pre xPAP time for me.) That did work well for my stomach for a month or two, of course, bacteria comes back. Then I did the last thing, I started using a bi level machine, like the one you have. My Primary Care Physician said he thought I could do without stomach meds, like Prilosec last summer. I ran out of money to buy those things, so I bought some bottles of Maloxx to get through the end of the month. Son of a Gun, the GERD did stop troubling me.

Keep in mind that it is a multi-sided problem. The GERD brings stomach acid up my esophagus, by either sump pump effect or stomach upset. That stomach acid, gets into the top of my wind pipe, also floats up into my nose. My nose and sinuses begin to drip. which gets into my throat, and makes me cough. Some of those two things gets back into my stomach, that brings more bacteria into my stomach, which. . . . . .

Problem none of that has anything to do with your issues. I have the feeling you have checked to make sure you have the correct pressures (for you) on your machine. My not having the right pressures would set off my stomach issues again.

Keep in mind that having leaks would create gasping, which creates the sump pump effect against the stomach, which brings up stomach acid. and so on.

I am not sure any of this has any thing to do with your issues. Just raising the points for you to ponder. I would think the Lisinoprel thing might be worth pursuing. I know my PCP love Lisinoprel for its protective benefits for the kidneys (for a diabetic like myself). I really find it hard to love a drug that is also part of what makes my diabetes worse. I really like to eat, so diabetes is really not a fun disease for me.