Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Is Allergic Bronchopulmonary Aspergillosis?
Question: Dear Sir,
I am 36 years of age, living in XXXXXXX Since September 2012 i am living under a kind of continous breathing attack. The doctor has stated it is ABPA, as per articles online, i found it very depressing.
The details of my medication BEFORE and AFTER diagnosis is reproduced below:
BEFORE DIAGNOSIS
Breathing trouble since 15th September, 2012.
Symptoms:
Trouble breathing with a lot of wheezing and mucus falling inside for 24 hours a day.
History :
No asthama complaints earlier, no family history. In fact was absolutely fit and playing badminton regularly. Only due to seasonal allergy once a year have trouble breathing for a day or two taken care by medicine.
Initial Medication :
Nebulizer, antibiotics and anti allergies from a local doctor but it didn’t helped, problem aggravated.
Went to Inscol Hospital for cough & COMPLETE breathlessness:
28-Sep-2012 Prescription; (Administered : Injection Hypocort 100, Nebulisation (Budecort)Medicine Levoflox 500 mg, Synasma 400mg, Montair LC,) and X-ray was conducted
05-Oct-2012 Prescription; (Rotacaps (Revolizer), Montair LC )
15-Oct-2012 Prescription; (Rotacaps (Revolizer), Montair LC ( Told to continue)
NO IMPROVEMENT in SEVERE breathlessness only temporary subsiding due to medicine. Tried Homeopathy in between for a month, no use.
Went to ENT, Government Hospital Sector 16, XXXXXXX there taking MUCOMELT, ALERFIX TOTAL, CYFOLAX etc for around two months but no improvement. The problem use to subside temporarily, till then due to continous unease in breathing for months started experiencing pain in my chest/lungs.
In April went to another clinic. The Doctor without waisting time administered me injection and gave me montair, theoasthalin, broxhemine. He also asked to get a CT scan done
Detail of CT Scan observation
Mild B/L Central Tubular bronchiectasis ( No pleural effusion, pneumothorax or pleural calcification seen, Chest wall normal, No nodules/bronchoceles/mucus plugging/tree in bud opacities seen, lung interstitium is grossly normal)
Thanks to him, on the basis of CT Scan he requested me to visit Pulmonary department of Govt Hospital Sector 32, XXXXXXX
PULMONARY MEDICINE
20.04.13 Prescription : (Foracort/rotacaps 200 mg, Unicontin E (400), Montair LC)
(TO BE CONTINUED TILL NEXT CHECK UP)
(IGE > 3000 (0-378 IU/ml) on 22.04.13).
No problems in breathing with medicines.
16.05.13 Prescription : (Foracort/rotacaps 200 mg, Unicontin E (400), Montair LC)
(TO BE CONTINUED TILL NEXT CHECK UP)
No problems in breathing with medicines
(Diagnosed as ABPA ON THE BASIS OF IGE report)
15.06.13 Prescription : (Wysolone 20 mg daily, Foracort/rotacaps 200 mg, Unicontin E (400), Montair LC). ( TO BE CONTINUED TILL NEXT CHECK UP)
(IGE = 1784 (0-378 IU/ml) on 17.07.13).
No problems in breathing with medicines
31.08.13 Prescription : (Montair LC replaced by Allegra 120, Foracort/rotacaps 200 mg, Unicontin E (400),
(IGE = 850 (0-378 IU/ml) on 18.09.13).
No problems in breathing with medicines
05.10.13 Prescription : (Wysolone 20 mg replaced by Wysolone 10 mg daily, Foracort 200 mg replaced with Combihale FF 100 mg (Twice, but was only taking it once as i felt comfortable), Unicontin E (400) & Allegra 120 Continued)
(Doubtful whether breathlessness started or not after reducing medicines as mentioned above).
16.11.13 Prescription :
(Wysolone 20 mg replaced by Wysolone 10 mg daily, Combihale FF 100 mg, Unicontin E (400) & Allegra 120 Continued)
(Experience breathlessness & mucus in the morning).
16.11.13 Prescription :(Wysolone 10 mg to alternate day from daily, Combihale FF 100 mg, Unicontin E (400) & Allegra 120 Continued)
(Experience breathlessness & mucus in the morning).
11.12.13 Prescription : Continued as above,
(Experience breathlessness & mucus in the morning).
11.12.13 Prescription :Continued as above,
(Experience breathlessness & mucus in the morning).
18.01.14 Prescription :Continued as above,
(IGE = 618.40 (0-378 IU/ml) on 18.01.14).
(Experience breathlessness & mucus in the morning).
08.03.14 Prescription : (Wysolone 10 mg alternate day, Combihale FF 100 mg, Unicontin E (400)
Allegra 120 increased to Montair FX).
(IGE = 550 (0-378 IU/ml) on 08.03.14).
(Problem controlled but mouth stayed dry the whole day so took Montair LC instead of FX).
19.04.14 Prescription : (Wysolone 10 mg alternate day to daily, Combihale FF 100 mg, Unicontin E (400)
Allegra 120).
(IGE = 550 (0-378 IU/ml) on 08.03.14).
(Head Heaviness, dizziness till noon, high mucus)
19.04.14 Prescription :(Wysolone 10 mg alternate day to daily, Combihale FF 100 mg, Unicontin E (400)
Allegra 120).
(IGE = 550 (0-378 IU/ml) on 08.03.14).
(Head Heaviness, dizziness till noon, high mucus)
02.08.14 Prescription :(Wysolone 10 mg daily, Combihale FF 100 mg increased to Comb 250,, Unicontin E (400)).
(IGE = 730 (0-378 IU/ml) on 08.03.14).
(Not taking Montair LC, tightness in breath whole day)
25.10.14 Prescription : (No Wysolone,Combihale FF 250, Montair LC*15 days. Unicontin E).
(IGE = 540 (0-378 IU/ml) on 09.09.14).
29.11.14 Prescription : (Combihale FF 250, Montair LC*15 days. Zifi Lbx * 7 days).
(IGE = 700 (0-378 IU/ml) on 29.11.14).
Presently taking only Combihale 100 (Once) in morning and Montair LC (Once) in evening. Though doctor says situation has improved i still have mucus that keeps falling inside occaisonaly mostly in the morning, wheezing in the morning if i donot take Montair LC. Sometimes i feel like cramps in and around the right side of my ribcage.
I have read articles about ABPA which states that it generally happens to people with Asthama. I never had asthama problem, as I have been a healthy individual allthrough my life.
I have also started taking ayurvedic medicine but i don’t know if its helping.
Side effects: Body aches on starting/stoping Montair LC after a long gap. Continous feeling of pricking in my body when Allegra 120 or Montair LC is not taken ( may be because of some allergy in blood as IGE is high)
ON THE BASIS OF ABOVE
Please advise:
1. If i am taking the right treatment. What is ABPA, as i believe i have only allergy and it should not be asthama. A friend of mine has asthama and there is permanent huskiness in his voice and wheezing when he speaks which is missing in my case. BUT i cannot breath without medicines. Am i in a bigger problem.
2. Its a disease or a condition and if it is pulmonary problem.
3. Should i ask my doctor to conduct some other tests except IGE to confirm if its ABPA
4. Presently i am able to spend my day with one Combihale FF 100 (Once in morning) and Montair LC ( Once in evening).
5. I am not able to be off medicine even after IGE has come down from 3000+ to 500. Do i need more steroids
6. Steroids help in short duration relaxation of breathing or long term.
7. Will i be able to come off these medicines any time in my life.
8. In this winters i am without steroids, only montair LC as an oral medicine. But in mornings i wake up with body aches and yellow/green mucus i need to cough out (may be because of ayurvedic medicine). The rest of the day goes OK.
9. Should i be getting myself checked in PGI-MER as that is a research institute.
When I recollect, we had dampness on the wall in the drawing room of our house in September 2012, leading to the paint coming off like cotton plugs from the wall due to construction work going on at neighbour’s house. One of the article also talks about this fungus in the damp buildings. I am not sure if i can align my problem with the paint issue in the house as both started simultaneously if believe.
I am 36 years of age, living in XXXXXXX Since September 2012 i am living under a kind of continous breathing attack. The doctor has stated it is ABPA, as per articles online, i found it very depressing.
The details of my medication BEFORE and AFTER diagnosis is reproduced below:
BEFORE DIAGNOSIS
Breathing trouble since 15th September, 2012.
Symptoms:
Trouble breathing with a lot of wheezing and mucus falling inside for 24 hours a day.
History :
No asthama complaints earlier, no family history. In fact was absolutely fit and playing badminton regularly. Only due to seasonal allergy once a year have trouble breathing for a day or two taken care by medicine.
Initial Medication :
Nebulizer, antibiotics and anti allergies from a local doctor but it didn’t helped, problem aggravated.
Went to Inscol Hospital for cough & COMPLETE breathlessness:
28-Sep-2012 Prescription; (Administered : Injection Hypocort 100, Nebulisation (Budecort)Medicine Levoflox 500 mg, Synasma 400mg, Montair LC,) and X-ray was conducted
05-Oct-2012 Prescription; (Rotacaps (Revolizer), Montair LC )
15-Oct-2012 Prescription; (Rotacaps (Revolizer), Montair LC ( Told to continue)
NO IMPROVEMENT in SEVERE breathlessness only temporary subsiding due to medicine. Tried Homeopathy in between for a month, no use.
Went to ENT, Government Hospital Sector 16, XXXXXXX there taking MUCOMELT, ALERFIX TOTAL, CYFOLAX etc for around two months but no improvement. The problem use to subside temporarily, till then due to continous unease in breathing for months started experiencing pain in my chest/lungs.
In April went to another clinic. The Doctor without waisting time administered me injection and gave me montair, theoasthalin, broxhemine. He also asked to get a CT scan done
Detail of CT Scan observation
Mild B/L Central Tubular bronchiectasis ( No pleural effusion, pneumothorax or pleural calcification seen, Chest wall normal, No nodules/bronchoceles/mucus plugging/tree in bud opacities seen, lung interstitium is grossly normal)
Thanks to him, on the basis of CT Scan he requested me to visit Pulmonary department of Govt Hospital Sector 32, XXXXXXX
PULMONARY MEDICINE
20.04.13 Prescription : (Foracort/rotacaps 200 mg, Unicontin E (400), Montair LC)
(TO BE CONTINUED TILL NEXT CHECK UP)
(IGE > 3000 (0-378 IU/ml) on 22.04.13).
No problems in breathing with medicines.
16.05.13 Prescription : (Foracort/rotacaps 200 mg, Unicontin E (400), Montair LC)
(TO BE CONTINUED TILL NEXT CHECK UP)
No problems in breathing with medicines
(Diagnosed as ABPA ON THE BASIS OF IGE report)
15.06.13 Prescription : (Wysolone 20 mg daily, Foracort/rotacaps 200 mg, Unicontin E (400), Montair LC). ( TO BE CONTINUED TILL NEXT CHECK UP)
(IGE = 1784 (0-378 IU/ml) on 17.07.13).
No problems in breathing with medicines
31.08.13 Prescription : (Montair LC replaced by Allegra 120, Foracort/rotacaps 200 mg, Unicontin E (400),
(IGE = 850 (0-378 IU/ml) on 18.09.13).
No problems in breathing with medicines
05.10.13 Prescription : (Wysolone 20 mg replaced by Wysolone 10 mg daily, Foracort 200 mg replaced with Combihale FF 100 mg (Twice, but was only taking it once as i felt comfortable), Unicontin E (400) & Allegra 120 Continued)
(Doubtful whether breathlessness started or not after reducing medicines as mentioned above).
16.11.13 Prescription :
(Wysolone 20 mg replaced by Wysolone 10 mg daily, Combihale FF 100 mg, Unicontin E (400) & Allegra 120 Continued)
(Experience breathlessness & mucus in the morning).
16.11.13 Prescription :(Wysolone 10 mg to alternate day from daily, Combihale FF 100 mg, Unicontin E (400) & Allegra 120 Continued)
(Experience breathlessness & mucus in the morning).
11.12.13 Prescription : Continued as above,
(Experience breathlessness & mucus in the morning).
11.12.13 Prescription :Continued as above,
(Experience breathlessness & mucus in the morning).
18.01.14 Prescription :Continued as above,
(IGE = 618.40 (0-378 IU/ml) on 18.01.14).
(Experience breathlessness & mucus in the morning).
08.03.14 Prescription : (Wysolone 10 mg alternate day, Combihale FF 100 mg, Unicontin E (400)
Allegra 120 increased to Montair FX).
(IGE = 550 (0-378 IU/ml) on 08.03.14).
(Problem controlled but mouth stayed dry the whole day so took Montair LC instead of FX).
19.04.14 Prescription : (Wysolone 10 mg alternate day to daily, Combihale FF 100 mg, Unicontin E (400)
Allegra 120).
(IGE = 550 (0-378 IU/ml) on 08.03.14).
(Head Heaviness, dizziness till noon, high mucus)
19.04.14 Prescription :(Wysolone 10 mg alternate day to daily, Combihale FF 100 mg, Unicontin E (400)
Allegra 120).
(IGE = 550 (0-378 IU/ml) on 08.03.14).
(Head Heaviness, dizziness till noon, high mucus)
02.08.14 Prescription :(Wysolone 10 mg daily, Combihale FF 100 mg increased to Comb 250,, Unicontin E (400)).
(IGE = 730 (0-378 IU/ml) on 08.03.14).
(Not taking Montair LC, tightness in breath whole day)
25.10.14 Prescription : (No Wysolone,Combihale FF 250, Montair LC*15 days. Unicontin E).
(IGE = 540 (0-378 IU/ml) on 09.09.14).
29.11.14 Prescription : (Combihale FF 250, Montair LC*15 days. Zifi Lbx * 7 days).
(IGE = 700 (0-378 IU/ml) on 29.11.14).
Presently taking only Combihale 100 (Once) in morning and Montair LC (Once) in evening. Though doctor says situation has improved i still have mucus that keeps falling inside occaisonaly mostly in the morning, wheezing in the morning if i donot take Montair LC. Sometimes i feel like cramps in and around the right side of my ribcage.
I have read articles about ABPA which states that it generally happens to people with Asthama. I never had asthama problem, as I have been a healthy individual allthrough my life.
I have also started taking ayurvedic medicine but i don’t know if its helping.
Side effects: Body aches on starting/stoping Montair LC after a long gap. Continous feeling of pricking in my body when Allegra 120 or Montair LC is not taken ( may be because of some allergy in blood as IGE is high)
ON THE BASIS OF ABOVE
Please advise:
1. If i am taking the right treatment. What is ABPA, as i believe i have only allergy and it should not be asthama. A friend of mine has asthama and there is permanent huskiness in his voice and wheezing when he speaks which is missing in my case. BUT i cannot breath without medicines. Am i in a bigger problem.
2. Its a disease or a condition and if it is pulmonary problem.
3. Should i ask my doctor to conduct some other tests except IGE to confirm if its ABPA
4. Presently i am able to spend my day with one Combihale FF 100 (Once in morning) and Montair LC ( Once in evening).
5. I am not able to be off medicine even after IGE has come down from 3000+ to 500. Do i need more steroids
6. Steroids help in short duration relaxation of breathing or long term.
7. Will i be able to come off these medicines any time in my life.
8. In this winters i am without steroids, only montair LC as an oral medicine. But in mornings i wake up with body aches and yellow/green mucus i need to cough out (may be because of ayurvedic medicine). The rest of the day goes OK.
9. Should i be getting myself checked in PGI-MER as that is a research institute.
When I recollect, we had dampness on the wall in the drawing room of our house in September 2012, leading to the paint coming off like cotton plugs from the wall due to construction work going on at neighbour’s house. One of the article also talks about this fungus in the damp buildings. I am not sure if i can align my problem with the paint issue in the house as both started simultaneously if believe.
Brief Answer:
it is an immunologically mediated disorder.
Detailed Answer:
Hello dear, thanks for your question on HCM and for the detailed history.
I can understand your situation and problem.
Answer to your 1st question.
Treatment is appropriate but antifungal (itraconazole) should be started in your case. ABPA (Allergic BronchoPulmonary Aspergilloses) is an immunologically mediated disorder caused by chronic colonization of fungus named Aspergillus Fumigatus in the lungs. This disease is having phases like acute exacerbation, remission, fibrotic, end stage etc. So drugs are given to keep ABPA in remission phase and avoid exacerbation. It is due to IgE mediated hypersensitivity. So I will say ABPA is chronically manageable disease like hypertension and diabetes.
Answer to your 2nd question.
It is a disease or lungs caused by hypersensitivity (IgE mediated) to the fungus named Aspergillus Fumigatus.
Answer to your 3rd question.
Yes, you should ask for following test to confirm ABPA.
1. Total IgG (should be raised)
2. Aspergillus specific IgE (should be raised)
3. Aspergillus specific IgG (should be raised)
Answer to your 4th question.
Better to take inhaler twice daily as combihale FF is having salmeterol and fluticasone. Both is having action for 10-12 hours. So twice daily dosing is needed for better control.
Answer to your 5th question.
Oral Steroid should be given in alternate day in low doses if exacerbation is suspected. Otherwise inhaled corticosteroid (fluticasone) is good for remission.
Answer to your 6th question.
Oral steroids will give you short relief, so should be started when exacerbation is suspected. Inhaled steroids should be continued. This will give you long term relief.
Answer to your 7th question.
Well, this is a tricky situation. I am not sure for the life long but you need to take medicines for atleast 2 years. And in my opinion you should be put on itraconazole. So discuss about its role in your case with your doctor.
Answer to your 8th question.
You are taking inhaler once only. So full 24 hour protection is not achieved. So start inhalers twice daily and your this morning problem will be solved.
Answer to your 9th question.
Yes, you can definitely consult pulmonology department in PGI, XXXXXXX as it an Apex institute of XXXXXXX
And yes, this fungus can be due to damp building.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.
it is an immunologically mediated disorder.
Detailed Answer:
Hello dear, thanks for your question on HCM and for the detailed history.
I can understand your situation and problem.
Answer to your 1st question.
Treatment is appropriate but antifungal (itraconazole) should be started in your case. ABPA (Allergic BronchoPulmonary Aspergilloses) is an immunologically mediated disorder caused by chronic colonization of fungus named Aspergillus Fumigatus in the lungs. This disease is having phases like acute exacerbation, remission, fibrotic, end stage etc. So drugs are given to keep ABPA in remission phase and avoid exacerbation. It is due to IgE mediated hypersensitivity. So I will say ABPA is chronically manageable disease like hypertension and diabetes.
Answer to your 2nd question.
It is a disease or lungs caused by hypersensitivity (IgE mediated) to the fungus named Aspergillus Fumigatus.
Answer to your 3rd question.
Yes, you should ask for following test to confirm ABPA.
1. Total IgG (should be raised)
2. Aspergillus specific IgE (should be raised)
3. Aspergillus specific IgG (should be raised)
Answer to your 4th question.
Better to take inhaler twice daily as combihale FF is having salmeterol and fluticasone. Both is having action for 10-12 hours. So twice daily dosing is needed for better control.
Answer to your 5th question.
Oral Steroid should be given in alternate day in low doses if exacerbation is suspected. Otherwise inhaled corticosteroid (fluticasone) is good for remission.
Answer to your 6th question.
Oral steroids will give you short relief, so should be started when exacerbation is suspected. Inhaled steroids should be continued. This will give you long term relief.
Answer to your 7th question.
Well, this is a tricky situation. I am not sure for the life long but you need to take medicines for atleast 2 years. And in my opinion you should be put on itraconazole. So discuss about its role in your case with your doctor.
Answer to your 8th question.
You are taking inhaler once only. So full 24 hour protection is not achieved. So start inhalers twice daily and your this morning problem will be solved.
Answer to your 9th question.
Yes, you can definitely consult pulmonology department in PGI, XXXXXXX as it an Apex institute of XXXXXXX
And yes, this fungus can be due to damp building.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Sir, thanks a lot for reply... I guess my general doubts except pointers in the conversation are not resolved and your reply has raised further doubts in my mind :
1. What is acute exacerbation ( as this term is related to COPD, which i feel i don't have), what is remission phase and how do i know i am at what stage in ABPA.
2. As asked earlier, please reply on why mucus keeps falling inside occasionally mostly in the MORNING MAJORLY, difficulty in breathing in morning if i do not take Montair LC. For me every morning is a problem for e.g if i leave montair and go to a lower medicine allegra 120 than the moment i get up from the bed i feel difficulty in breathing and have to take FF 100.
3.Sometimes i feel like cramps/contraction feeling in and around the right side of my rib cage. Why?
4. Why even with a very low IGE, breathing not improving.
5. Question no. 6 asked earlier i will rephrase: After a long use of steroid (Wysolone 20/10mg) for around more than one year my breathing is far better than when i was not diagnosed ABPA i.e not started taking steroids. Now i need to know is it because of the use of steroids that inflammation has been controlled and if it is so, should i ask my doctor to start steroids again believing it will further lower inflammation in the long run as inhaled FF 100/250 give me only temporary relief for 10-12 hours. OR will the inhaled FF 100/250 will improve my situation in long run.
6. What does my CT-Scan denote about damage.
7. I had asked my doctor about anti fungal but he is not prescribing that right now and in any case i have been taking these medicines since XXXXXXX 2013 ( one and half year already). I dont know why.
8. How serious is my situation, allthough i am ok with medicine and can take good walks and slight running as well... May be i am thinking too much into the situation.
Regards
1. What is acute exacerbation ( as this term is related to COPD, which i feel i don't have), what is remission phase and how do i know i am at what stage in ABPA.
2. As asked earlier, please reply on why mucus keeps falling inside occasionally mostly in the MORNING MAJORLY, difficulty in breathing in morning if i do not take Montair LC. For me every morning is a problem for e.g if i leave montair and go to a lower medicine allegra 120 than the moment i get up from the bed i feel difficulty in breathing and have to take FF 100.
3.Sometimes i feel like cramps/contraction feeling in and around the right side of my rib cage. Why?
4. Why even with a very low IGE, breathing not improving.
5. Question no. 6 asked earlier i will rephrase: After a long use of steroid (Wysolone 20/10mg) for around more than one year my breathing is far better than when i was not diagnosed ABPA i.e not started taking steroids. Now i need to know is it because of the use of steroids that inflammation has been controlled and if it is so, should i ask my doctor to start steroids again believing it will further lower inflammation in the long run as inhaled FF 100/250 give me only temporary relief for 10-12 hours. OR will the inhaled FF 100/250 will improve my situation in long run.
6. What does my CT-Scan denote about damage.
7. I had asked my doctor about anti fungal but he is not prescribing that right now and in any case i have been taking these medicines since XXXXXXX 2013 ( one and half year already). I dont know why.
8. How serious is my situation, allthough i am ok with medicine and can take good walks and slight running as well... May be i am thinking too much into the situation.
Regards
Brief Answer:
Acute exacerbation means worsening symptoms beyond normal
Detailed Answer:
Hello dear,thanks for your question on HCM.
Answer to your 1st question.
Acute exacerbation means worsening symptoms beyond routine normal, day to day variations.
If you have developed acute onset of breathlessness or wheezing then it is known as exacerbation.
Same way remission is a stage in which symptoms are remained in stable form due to maintenance drugs.
For staging you need clinical, radiological and pathological parameters. Combination of all these decide stage.
Answer to your 2nd question.
Mucus production in your case is due to inflammation. Since you are taking inhaled drugs once daily, proper control is not achieved. And this is further aggravated by not taking montair lc tablet. So my advice is to take combihale ff twice daily and montair lc at night.
Answer to your 3 rd question.
This may be due to localized spasm in the area of bronchiectesis.
Answer to your 4th question.
This is because of central bronchiectesis , you are having. This are structural changes and give you mucus production, inflammation and breathlessness occasionally. This is the reason, you should take inhaled treatment regularly.
Answer to your 5th question.
Oral steroids are bilayered sword. It is helpful in controlling inflammation, at the same time it will cause more side effects. So better to use it cautiously. Better to take combihale FF twice daily because this is the ideal dose for it. Its action lasts for 10-12 hours only. And inhaled steroids are far far batter than oral steroids in aspect of side effect. My suggestion is to start antifungal, not oral steroid. Because itraconazole is having clear cut indication in ABPA.
Answer to your 6th question.
Your CT scan shows bilateral cental bronchiectesis. This is one of the characteristic of ABPA. It is structural damage. Treatment is needed to prevent its progression.
Answer to your 7th question.
I am in strong favour of antifungal in your case. I don't know why your treating doctor had not given you in almost 2 years of treatment. Better to consult PGI XXXXXXX They will guide you in better way.
Answer to your 8th question.
As said earlier, your disease is chronically manageable disease just like hypertension and diabetes. We need to titrate medicines according to your condition. For this regular follow up with pulmonologist is needed.
No need to think negatively over these disease. Proper counselling is needed to understand this disease. So better to consult good pulmonologist.
Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Acute exacerbation means worsening symptoms beyond normal
Detailed Answer:
Hello dear,thanks for your question on HCM.
Answer to your 1st question.
Acute exacerbation means worsening symptoms beyond routine normal, day to day variations.
If you have developed acute onset of breathlessness or wheezing then it is known as exacerbation.
Same way remission is a stage in which symptoms are remained in stable form due to maintenance drugs.
For staging you need clinical, radiological and pathological parameters. Combination of all these decide stage.
Answer to your 2nd question.
Mucus production in your case is due to inflammation. Since you are taking inhaled drugs once daily, proper control is not achieved. And this is further aggravated by not taking montair lc tablet. So my advice is to take combihale ff twice daily and montair lc at night.
Answer to your 3 rd question.
This may be due to localized spasm in the area of bronchiectesis.
Answer to your 4th question.
This is because of central bronchiectesis , you are having. This are structural changes and give you mucus production, inflammation and breathlessness occasionally. This is the reason, you should take inhaled treatment regularly.
Answer to your 5th question.
Oral steroids are bilayered sword. It is helpful in controlling inflammation, at the same time it will cause more side effects. So better to use it cautiously. Better to take combihale FF twice daily because this is the ideal dose for it. Its action lasts for 10-12 hours only. And inhaled steroids are far far batter than oral steroids in aspect of side effect. My suggestion is to start antifungal, not oral steroid. Because itraconazole is having clear cut indication in ABPA.
Answer to your 6th question.
Your CT scan shows bilateral cental bronchiectesis. This is one of the characteristic of ABPA. It is structural damage. Treatment is needed to prevent its progression.
Answer to your 7th question.
I am in strong favour of antifungal in your case. I don't know why your treating doctor had not given you in almost 2 years of treatment. Better to consult PGI XXXXXXX They will guide you in better way.
Answer to your 8th question.
As said earlier, your disease is chronically manageable disease just like hypertension and diabetes. We need to titrate medicines according to your condition. For this regular follow up with pulmonologist is needed.
No need to think negatively over these disease. Proper counselling is needed to understand this disease. So better to consult good pulmonologist.
Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
