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Suggest Treatment For Severe Asthma
Posted on
Sun, 4 Jan 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 4 Jan 2015
Answered on
Mon, 2 Feb 2015
Last reviewed on
Question : I have severe asthma and copd . I use a duolin inhaler which lasts me about one week. My condition was not caused by smoking but by a severe hiatal hernia at age 25 yrs am now 4 months from 75. I have insulin dependent diabetes and have to go on methylprednisolone about every three months. If you were me what would you do different. ---XXXXXX
Brief Answer:
PFTs, HRCT Chest, V/Q Scan. Supportive medication.
Detailed Answer:
Hi,
Thank you for your query.
1. The problem is with the overlap of the symptoms and medication of asthma and COPD and the fact that both may co-exist. Long term asthma such as in your case will give rise to COPD like symptoms.
2. Get Pulmonary Function Tests (PFTs) done. Upper airway up to the first dozen or so divisions is more likely to respond to bronchodilators. Steroids will be more effective in the smallest airways and lung tissue. (as there is very less musculature in the smallest divisions, emphysema [air sac destruction] and decreased lung. elasticity in COPD). Short courses of oral steroids like the methylprednisolone that you take about every three months will reduce the frequency of the attacks but cannot stop the progress or reverse COPD. Long term oral steroids are not recommended in your case as you have diabetes and due to the risks of chronic steroid use. An HR (High Resolution) CT Scan of the Chest with a lung ventilation/perfusion (V/Q) nuclear imaging scan will also help.
3. In COPD, mucolytics, chest physiotherapy, a home based oxygen concentrator, bronchodilators with steroids and avoiding tobacco smoke, air pollution will help. In Asthma, anti-allergic, brochodilators with steroids and avoiding trigger factors will help.
4. These differences may explain why a the albuterol (bronchodilator) did not work, while the duolin (steroid plus bronchodilator) works in your case.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
PFTs, HRCT Chest, V/Q Scan. Supportive medication.
Detailed Answer:
Hi,
Thank you for your query.
1. The problem is with the overlap of the symptoms and medication of asthma and COPD and the fact that both may co-exist. Long term asthma such as in your case will give rise to COPD like symptoms.
2. Get Pulmonary Function Tests (PFTs) done. Upper airway up to the first dozen or so divisions is more likely to respond to bronchodilators. Steroids will be more effective in the smallest airways and lung tissue. (as there is very less musculature in the smallest divisions, emphysema [air sac destruction] and decreased lung. elasticity in COPD). Short courses of oral steroids like the methylprednisolone that you take about every three months will reduce the frequency of the attacks but cannot stop the progress or reverse COPD. Long term oral steroids are not recommended in your case as you have diabetes and due to the risks of chronic steroid use. An HR (High Resolution) CT Scan of the Chest with a lung ventilation/perfusion (V/Q) nuclear imaging scan will also help.
3. In COPD, mucolytics, chest physiotherapy, a home based oxygen concentrator, bronchodilators with steroids and avoiding tobacco smoke, air pollution will help. In Asthma, anti-allergic, brochodilators with steroids and avoiding trigger factors will help.
4. These differences may explain why a the albuterol (bronchodilator) did not work, while the duolin (steroid plus bronchodilator) works in your case.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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