Brief Answer:
Add montelukast, allergy testing, lifestyle change

Detailed Answer:
Hello.

Thank you for asking at HCM.

I went through your daughter's history and would like to know more about her like:

a. Does she have nose congestion? Does she have loss of smell?

b. Does she have repeated headaches or facial pains/heaviness?

c. Does she have regurgitation of foods/fluids after heavy or hot/spicy meals? Does she have burning in chest?

d. Does she have any ear problems - ear fullness, etc?

e. Does she have eye symptoms - eye redness, itching, excessive lacrimation?

f. How was she diagnosed asthma? Does she wheeze? Does she have breathing difficulties? What is the frequency of her asthma symptoms?

g. Which are the worst seasons for her?

h. Does she have/ did she have any skin complaints/skin allergies?

i. Did she have any allergic complaints/repeated respiratory complaints in childhood?

j. Is she exposed to smoke or dusts or air pollution?

k. Does she any one in family with allergies/asthma?

l. Can you please upload her spirometry report, blood report and any other reports on follow-up. They will be helpful to me.

Please give me above details on follow-up. I will be able to help her better with above mentioned details.

From your current history, I would like to make suggestions for you as follows:

1. I assume she has nose symptoms almost throughout the year.

I would suggest her to continue Flutiflo nasal spray for symptoms relief. Please ensure her technique of using nasal spray is correct.

2. Were I treating her, I would add regular montelukast. It will help both nose symptoms and asthma symptoms.

3. I would suggest her to keep salbutamol inhaler with her, which is to be used for asthma symptoms (breathlessness, wheezing) on as-and-when-needed basis. Please note that it is not to be used on regular basis.

Depending upon her details of symptoms and spirometry report, it can be decided whether she needs regular inhalers for asthma.

4. It is important to note that all above medicines will "control" her symptoms of allergic rhinitis and asthma, they do not "cure" allergies.

Also, please be sure that with long history such as 1.5 years, personally I would think of allergy and not of infection. Rhinitis (nose symptoms), sinusitis and asthma - all three can be caused by allergies and are interlinked. Of course, in-between infections can worsen her symptoms.

5. As an Allergist-Immunologist, I would suggest her allergy testing for air-borne allergens - house dust mite, cockroach proteins, common molds and pollens in your area and animal dander (if she has pet at home).

If her symptoms worsen with ingestion of particular food, I would suggest her allergy testing for that particular food also. Common foods causing allergies are peanut, milk, wheat, egg, soy, rice, fish, shell fish and tree nuts.

There are two types of allergy testing available - skin testing which is more reliable and is performed by Allergist-Immunologists and blood testing which can be performed sometimes if necessary.

Allergy testing will help her to know the substances she is allergic to and also to know the measures to avoid exposure to them.

6. Depending upon results of allergy testing, an Allergist-Immunlogist may prescribe her allergen specific aimmunotherapy which works on her immune system to improve gradually allergy symptoms for long term.

7. In addition to above, I would suggest her to avoid exposure to dusts, smokes and air pollution.

8. I would also suggest her regular breathing exercises (including Yoga & Pranayama) and a balanced diet rich in vitamins, minerals & antioxidants (adequate amounts of green leafy vegetables, fruits, sprouts, etc) which will help her in a long term by improving her lung capacity and immunity respectively.

Hope above suggestions will be helpful to you and her.

Regarding to your query, (which type of doctor is best) - personally I would suggest it requires a team approach involving an ENT specialist (for nose & sinuses), an Allergist-Immunologist (for allergies & immunotherapy) and sometimes pulmonologist (for difficult asthma). Of course, I have also seen many good results with complementary and alternative systems (like Ayurveda, Homeopathy, herbal medicine, Chinese medicine, etc) in allergies & asthma.

I am really sorry regarding your another query, as suggesting a particular doctor is against the term and conditions of HCM

Should you have any further query, please feel free to ask on follow-up. I can understand your concern and it is true that allergies require careful and long-term management but with proper treatment and understanding, it is very much possible to live a normal life. It will be my humble pleasure to help her with best of my knowledge and experience.

Wish your sister the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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Brief Answer:
Previous suggestions, steam inhalation

Detailed Answer:
Hello XXXX

Thank you very much for your follow-up.

I went through your sister's further details and would like to add to my previous answer as follows:

1. I would agree to the treatment that I had mentioned previously, important thing is pain below eyes, headache, etc suggest associated sinusitis (which was also shown in X-ray) which requires longer treatment with the same medications.

To repeat, I would suggest to continue nasal spray Flutiflo with proper technique, add montelukast regularly as well as to use salbutamol inhaler on as-and-when-needed basis for asthma symptoms.

2. Regarding montelukast, yes, it is a tablet and I usually prescribe it to be taken daily in evening.

3. I would like to emphasize here the importance of daily steam inhalation. I usually suggest my patients to inhale steam twice daily which help to reduce symptoms. This is a very simple measure but very effective in my opinion.

I would like to mention here that sinusitis can be associated with asthma and controlling sinusitis will also reduce her asthma symptoms.

4. As she has pain in tonsils/throat also, I would suggest her regular gargles with warm saline.

5. As suggested previously, I would suggest allergy testing, avoidance measures for allergy causing substances and allergen specific immunotherapy if possible.

6. If she has long standing nasal congestion and has not consulted an ENT surgeon in last 6 months, I would suggest to consult an ENT surgeon who will examine the nose cavity from inside and may find any associated structural problem.

Hope above suggestions will be helpful to her.

Of course, please upload the reports when possible.

Should you have any further query, please feel free to ask at follow-up.

Wish her the best of the health.

Thank you & Regards.

Dr. Parin N. Parmar

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