Question: Hello Doctor,
This query is going to be a little long so I would appreciate if you can read it thoroughly and help me.

This is regarding my mother who is 72 years old and is hypertensive for many years. She takes these medicines everyday - AMLONG, ATOCOR-10, ANGIZAAR-AT.

She was diagnosed with Acute Bronchitis in January 2014 and was admitted for 2 days in the hospital. She remained on oral medication for 7 days after discharge.

Now 15 days back suddenly she experienced shortness in breath. Even after walking a few steps she gets this breathing problem. She has swelling in her both feet but not elsewhere on the body. We saw the same doctor who treated her for Acute Bronchitis 5 months back. He recommended some tests and after performing PFT, Chest X-eay, Chest CT-Scan, 2D Echo he asked us to meet a Chest consultant as well as an ENT specialist in the same hospital.

Chest consultant said that there is interstitial thickening in her lungs and also there is pressure on one side of her heart (which he said should be < 25 but which actually is 58). He said that the windpipe has become lax and when my mother breathes out her trachea contracts 50%. He said that this related to age and that ENT won't be able to help here. He has prescribed these drugs to my mother - Abphylline, Mucinac 600, Rablet, Lasilactone, ASSURANS 20.

I still went ahead and met the ENT. And as expected he said he can't help much here and that the Chest consultant will treat my mother.

My queries to you are:

1. Does this thickening in lungs called Water in Lungs? or these are two different things?
2. How much treatable is this i.e. can this thickening be removed using Mucinac 600 medicine along with some steaming?
3. If the pressure on heart is 58 then can this be brought under control using ASSURANS medicine?
4. Is the lungs problem because of pressure on heart OR the pressure on heart is because of lungs problem i.e. which is because of which?
5. For swelling, what can be the real cause. Is it thickening in lungs OR pressure on heart?
6. Is the shortness of breath caused by lax/weak trachea OR is it because lungs are not clear due to thickening? And how can it be treated? Is surgery an option for trachea problem and if yes, then should it be opted for her at this age

I would be very obliged if you can answer my queries point by point as I am so worried about my mother's well being.

If required, I can share all the medical reports with you.

Hoping for a quick turnaround from your side.

Thanks
XXXX

Hello Doctor,

I am very very thankful for the quick and detailed response from you.

I have a couple of follow up questions based on your response and I hope you would be kind enough to answer these as well.

1. You mentioned surgery has no role here. But I just received call from the radiologist from the same hospital from where treatment is being done and he is kind of trying to force me to meet the ENT "Surgeon" (even though another ENT consultant in the same hospital said there is no role of ENT in this case). This radiologist even made me talk to the ENT surgeon who said the situation is very critical and that I must bring my mom there. Looks like they want to suggest surgery for trachea. Do you think surgery for trachea (and not for lungs/heart) is really required or advisable here?

2. If the thickening is due to fibrosis, and if it can not be removed, then is it possible to stop it from increasing further? or will it increase in any case we cannot stop it but can only slow it down ?

3. HRCT Chest and 2D ECHO were performed on my mother and the report contents are pasted below. I do not understand medical language but I am sure it will help you identify if it is Fibrosis or Fluid.

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HRCT CHEST
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Protocol: Axial sections of the chest has been done in HR mode and then repeated in spiral mode and documented in lung and mediastinal windows.

Observations:
On inspiratory CT the tracheal diameter is notmal, however on forced expiratory CT there is a greater than 50% reduction in the diameter of the tracheal lumen. The posterios tracheal membrane is seen bulging into the lumen. In more inferior section the tracheal lumen is assuming a lunate appearance s/o trachea bronchomalacia.
There is evidence of interlobal septal thickening with inter lobular thickening and ground glassing s/0 crazy paving pattern. In the right apical segment there is an area and focal lobular sparing. Similar focal lobular is also noted in the anterior segment of the left upper lobe.

On expiratory films there is evidence of mosaic attenuation s/o air trapping.
The pulmonary artery at the level of ascending aorta ~ 29.6 mm? pulmonary hypertension.

Evidence of bilateral pleural effusion more on the right side is noted.
The pulmonary vessel are enlarged with a A/B ratio > 1
The peribroncho vascular interstitium shows thickening.

IMPRESSION: Finding are s/o
1. Trachea bronchomalacia
2. Cardio genic pulmonary edema.

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ECHO REPORT
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FINAL IMPRESSION:
LA size is dilated
Other chambers are Normal
No regional wall motion abnormality is seen
Mild MR, Mild AR, Moderate to Severe TR RVSP=58+RAP Moderate to severe PAH
Grade 1 LV diastolic dysfunction
Normal LV systolic function, LVEF 55%
No Veg/Clot/PE
IVC is normal
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I would again like to thank for answering my previous queries. I hope you won't mind me asking too many questions. These are really important for me to know as I don't want to leave any stone un-turned for the well being of my mother.

Thank You,
XXXX

Thanks Doctor for patiently going through my long questions and then responding with equally detailed answers. I am indebted to you, Sir!

Well, before I close this discussion, one last thing I would like to ask from you.
My mother is also experiencing bad stomach i.e. after eating her meals she has to visit the washroom. Is it also because of the lung disease? She doesn't feel like eating much. Is it so that her liver has also got impacted and there is loss of appetite. She also says that after taking pills she feels as if something is pinching her inside the chest i.e. like pills are stuck somewhere in the chest and not going down.

My doctor here had said that after 10 days he will review and if required he will perform biopsy. So, I guess thats the best we can do.

Internet has benefits as well as drawbacks. People like me try to gather as much information as possible for their loved ones and then start bugging the doctors with lots and lots of questions. I got to read comments from patients and their relatives who had Fibrosis that how difficult life becomes in the last stages and that the prognosis is around 2-3 years. On one side it has scared me but on the other hand it is helping me to make up my mind about what we might face in coming days. Don't know if I should call it drawback or benefit of internet.

Thanks
XXXX