Brief Answer:
Add medications, allergy testing, life style modifications

Detailed Answer:
Hello,

Thank you for asking at HCM.

I went through your history and would like to know more about you:

a. Apart from bouts of breathlessness, do you have any nose complaints like - running nose, sneezing, blocked nose, nose itching, etc?

b. Do you have any eye symptoms like eye itching, redness, excess watering, etc?

c. Do you have frequent headaches, facial heaviness, etc?

d. Do you have frequent chest burning, feeling of sour water in mouth, especially after heavy/spicy meals?

e. Do you have any other medical condition? Are you taking any other drugs on frequent/regular basis?

f. What is the frequency of your breathlessness symptoms? How many times in a week or in a month?

g. Since what age do you have these complaints?

h. Which seasons are good and which ones are bad for your symptoms?

Above details would help me to know your symptoms better and therefore to guide you more specifically. Please provide them on next follow-up.

At present, I would suggest you as follows:

1. As Asthalin is not working for you for last for days, I would suggest you combination of budesonide and formoterol inhaler and oral montelukast in addition to asthalin inhaler to be used on as-and-when-needed basis.

2. I would also suggest you to take plenty of fluids, preferably warm fluids, during day to maintain hydration.

3. In general, please avoid exposure to dusts, smokes and air pollution as much as possible.

4. I would also suggest you allergy testing for common allergy causing substances such as house dust mites, molds, pollens, insect proteins and pet dander (if you have pets).

This will help you identify the substances causing allergies to you as well as to know the measures to avoid them.

5. Based on allergy testing, an Allergist-Immunologist may prescribe you allergen specific immunotherapy which gradually improves allergy symptoms be modifying immune system positively.

6. After recovery from current sickness, regular Yoga, Pranayama and exercises will help you to improve your lung capacity gradually.

7. A healthy diet rich in vitamins, minerals and antioxidants will also help you in a long run to improve your immunity.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up. Also, please provide the asked details on follow-up.

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

Thank you & regards,

Dr Parin N Parmar

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Brief Answer:
Medications, allergy testing & life style changes

Detailed Answer:
Hello XXXXXXX

Thank you for your follow-up.

I would like to make suggestions for you as follows:

1. Regarding medications, I would suggest you to take a combination of montelukast + levocetirizine tablet and a combination of budesonide + formoterol inhaler at present for at least next 4-6 weeks, in addition to the medications prescribed by your doctor.Discuss about this your doctor.

In addition, please take adequate rest, have plenty of warm fluids, light diet and warm saline gargles which would hasten your recovery.

2. Since you have often headaches, I would think of sinusitis. The treatment of it would include regular steam inhalation twice a day in addition to montelukast + levocetirizine as suggested. You could take an ENT opinion regarding confirmation of diagnosis sinusitis.

3. It's good that you informed about hypothyroidism, however, it usually does not interfere with allergies. Only make sure that it is controlled with regular thyoronorm.

4. I usually suggest my patients to use inhalers with attached spacer device, it ensures a better drug delivery into lungs. So if you find using such device comfortable, I would suggest to use it. (Only problem is that it increases the total size of the inhaler device)

5. Once you are recovered from the current episode, I would suggest you a detailed allergy testing as suggested previously. If immunotherapy is a good option for you (which can be known only after testing), it would help you to reduce frequency and severity of repeated symptoms and breathlessness.

6. As allergies & asthma are chronic disorders, diet, exercise and life style changes are very important to reduce intake of drugs and reduce avoidable suffering. Please try to follow suggestions made previously regarding diet, exercise and life style. I would also suggest you a good multivitamin-multimineral containing especially vitamin D, zinc, vitamin C, vitamin A, vitamin E, selenium, magnesium, etc for at least 2-3 months to boost your immunity.

7. Stress is an important aggravating factor for allergies & asthma. If it is a significant factor for you, please include relaxation and meditation in your life style to reduce stress.

As per T&Cs of HCM, I cannot suggest you a particular specialist in XXXXXXX However, I can suggest you to consult a pulmonologist for breathlessness, who will examine you, may suggest an investigation known as "spirometry" to know your lung capacity and will advise you regarding inhalers. I would also suggest you to consult an Allergist-Immunologist who will take your history in great detail and would suggest you allergy testing and immunotherapy, if appropriate.

Of course, there are many pulmonologists and allergists-immunologists in XXXXXXX both in corporate as well as private hospitals.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask at HCM.

Wish you the best of the health ahead.

Thank you & Regards,

Dr Parin N Parmar

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