Brief Answer:
Antacids for GERD & review asthma management

Detailed Answer:
Hello.

Thank you for asking at HCM.

I went through your history.

I would like to ask a few more questions like -
a. Apart from prednisolone, which drugs/inhalers do you use for asthma?
b. Are you using any daily medications for asthma?
c. How frequent are your episodes of asthma?
d.Do you have any other allergies/nose allergies/sinusitis?
e. Have you ever been tested for allergies?
f. Do you have any other medical conditions?
g.Do you take any other regular medications?
h. What were your last investigations suggestive of?
i. Are you exposed to dusts, smokes (including second hand smoking) or pollution on regular basis?
j. Since what age you are having asthma? How it was diagnosed?
k. Have you ever had spirometry? What were the last reports?
l. Are you overweight?

I will be able to help you more after knowing above details.

From your history, I would like to make following suggestions to you:

1. From your complaints of Heartburn and chest symptoms aggravated by tea, I would first think of GERD (Gastroesophageal Reflux Disease). Were I treating you, I would suggest you as follows:

a. I would prescribe antacids like ranitidine, omeprazole or pantoprazole (any one of them) 30 minutes before every meal for at least 6-8 weeks. This long duration of regular antacids is necessary for healing of esophageal mucosa.

b. I would suggest avoidance of tea, coffees, chocolates, hot & spicy foods/beverages for the same duration.

c. Oral corticosteroids (such as prednisolone) also can aggravate gastritis. So it is advisable to take antacids while you are taking oral corticosteroids.

2. If you need oral corticosteroids repeatedly, I would suggest you to use regular "controller" types of medications such as inhaled corticosteroids and montelukast. These will improve your asthma control and also will reduce need for oral corticosteroids.

For reviewing your asthma control management, I would suggest you to consult your regular doctor.

3. Personally I would suggest you to avoid exposure to dusts, smokes and air pollution as much as possible. Please do not smoke if you smoke. These all aggravate asthma symptoms.

4. Many times GERD and asthma are linked. Treatment of GERD will improve your asthma symptoms.

5. Regarding your complaints of fatiguability, personally I would suggest you to have a multivitamin with minerals and also take iron supplements if your hemoglobin is less than 13 g%.

If you had a viral fever recently, it would take a few weeks to recover.

6. I would like to know whether you are overweight. Being overweight/obese increases affects negatively all your complaints - GERD, asthma and fatigueability. In such case, weight reduction under expert guidance will help.

7. A simple diet rich in vitamins and minerals and anti-oxidants (e.g., adequate amounts of green leafy vegetables, fruits, sprouts, plenty of fluids, etc) will make you feel good and hasten recovery.



Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask. I will do my best to give you a helpful opinion.

Wish you the best of health.

Thank you & Regards.

Dr Parin N. Parmar

---

Brief Answer:
Add montelukast-antacids, discuss with your doctor

Detailed Answer:
Hello.

Thank you for your follow up.

I went through your details.

In addition to my suggestions in first answer, my opinion will be as follows:

1. If you still need daily albuterol 4 times a day, that suggests your asthma is not well controlled. Not only that, albuterol itself can aggravate GERD.

So, my important suggestion to you would be to tell your doctor about your upper abdomen symptoms. So that he can advise you about other options.

2. Were I treating you, I would add montelukast daily in your regular asthma controller treatment. Montelukast is a good drug for patients with both allergic rhinitis and asthma. Also, it can be used as steroid-sparing drug.

As you have allergic rhinitis also, a per my opinion, montelukast is a good option for you. You can discuss about this option with your doctor.

3. As suggested in my first answer, I would advice you regular antacids for your upper abdomen symptoms.

4. It's really good that you haven't had prednisolone course in last few years (apart from the recent one). So over the years, asthma has been stable. That is a good sign.

5. There are so many causes for fatigue/weakness. Viral infection (if it has caused asthma exacerbation), micronutrient (vitamins & minerals) deficiencies, even oral corticosteroids themselves can cause fatigue.

6. Should you have allergic rhinitis symptoms, you can continue using Flonase for them. Control of allergic rhinitis is also very important for control of asthma.

So, over the weeks, if your fatigue has been improving or steady, I don't think you should worry. You should talk about it with your doctor, but you will recover with time. Simple diet, rest and vitamin-mineral supplements will hasten the recovery.

Hope above suggestions will be helpful to you and solves your queries.

If you have any further query, you are most welcome to give follow up. It will be my humble pleasure to respond to them with best of my knowledge and efforts.

Wish you a quick recovery and the best of the health.

Thank you & Regards.

---