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Breathlessness, tiredness, giddiness, pedal oedema. Have chronic asthma and palpitations. Advice?

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Pulmonologist
Practicing since : 1979
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My wife ( 47 yrs ) is a chronic asthma patient since childhood. She had been finding difficulty to climb stairs for last 15 to 20 years due to shortness of breath. She also has palpitation for last 20 years ( Normal heart rate 85 to 110 ). Also recurrent pedal oedema & GERD for last 5 to 10 years . Frequency of pedal oedema once in 3 to 4 months & lasts for few says. During the same time she feels tired. Most often such episodes coincide with menstrual periods or urinary/gynological problems .
Recently she had acute onset of shortness of breath , tiredness , giddiness & pedal oedema . She was hospitalised for few days during mid-May . Pulmonary Angiogram & Doppler of limbs were normal . Her initial Echo showed 30 mm RVSP.which XXXXXXX to 50 mm during admission . Then WBC 0000. Hb - 9.7 , CRP - 15.2
Subsequently several repeat Echo done - No RVSP , 31 mm RVSP . 29 mm RVSP & 28 mm RVSP. Stress Echo was negative . TMT was mildly positive during recovery .
Recently CT coronary Angiogram was done - Normal.
Initial diagnosis was Pulmonary hypertension .Recently cardiologists & Pulmonologist Have arrived at Final diagnosis of COPD
Would request your kind analysis & advise regarding the disease & medication .
Presently she is on Budecort inhaler & Tiova inhaler on regular basis & Asthalin inhaler - SOS
DYTOR Plus for Oedema
Posted Wed, 5 Sep 2012 in Asthma and Allergy
 
 
Answered by Dr. Shashi Dangwal 2 hours later
Hi XXXXXXX

Thanx for visiting XXXXXXX

From your description your wife is suffering from asthma and most of the other problems are associated with it. A small percentage of people suffering from asthma also have COPD and vice versa. Raised RSVP means she has pulmonary hypertension which is a feature of both asthma and COPD.Long standing and inadequately controlled asthma becomes more and more difficult to treat.

Because of her asthma she is also having poor general health and that`s the reason of her low Hb, raised CRP and high TLC.

The mainstay of treatment of asthma is steroids. Inhaled steroids are preferred to minimize the side effects. I would suggest you start her on inhaled steroids available as seretide accuhaler or seroflo rotacaps(250 or 500mcg strength) twice a day. She should also take montair lc tablet once a day and doxyphyllin400 twice a day. If symptoms persist, a short course of oral steroids should be given for 5 to 7 days in addition.GERD can aggravated asthma symptoms and asthma can worsen GERD, hence give a ppi like rabeprazole and a prokinetic like lesuride for GERD. Her anaemia should be attended to.

She should avoid smoke and dust, extreme change in temp, artificial colourants and flavourants which are present in aerated drinks and processed food. Her meal times should be regular and she should have a good night sleep and adequate rest. XXXXXXX breathing exercises and walk in fresh air help.

I hope i have answered your query and it will be of help.
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Follow-up: Breathlessness, tiredness, giddiness, pedal oedema. Have chronic asthma and palpitations. Advice? 16 hours later
Dear Dr XXXXXXX

Many thanks for your evaluation & kind advise .

Does this mean she has all the 3 diseases - Asthma , COPD & Pulmonary Hypertension ?
Are COPD & Pulmonary hypertension curable & reversible ?
What kind of periodic checks should be done to know if Pulmonary hypertension still continues ? What is the upper normal RVSP limit ?
Regarding medication :
Since July she has started taking steroid inhaler - Budecort . Shall we substitute this with seretide accuhaler or seroflo rotacaps prescribed by you . Or this is another additional steroid ?
Other Drs had prescribed Maxflo & Esiflo inhalers.
Should she discontinue TIOVA inhaler ( Tiotropium Bromide ) started recently ?
Would you like to add any regular medication for Pulmonary Hypertension ?
Her Lung function test FEV 1 was around 73 % of predicted & not much improved after inhalation.
Report mentions DLCO reduced .
Also oxygen saturation before & after excercise - both were 98 %
I seek your kind valuable advise on above

Regards
XXXXXX
 
 
Answered by Dr. Shashi Dangwal 7 hours later
Hi XXXXXXX

Thanx for further input. I`ll try and answer your queries one by one:

Your wife mainly has long standing asthma with an element of COPD. Pul hypertension is a consequence of asthma/COPD and it is called secondary pul hypertension. I do not thing there is very significant element of pul hypertension in her case.

Asthma and COPD can be very well controlled with modern medicines available esp if started in early stage. It`s difficult to say that they are curable but with good control patient can lead a normal life and may even have long drug free intervals. However acute exacerbations can occur from time to time.

Initially check ups are more frequent at weekly or fortnightly interval and later monthly or even three monthly review suffices.

Normal pul artery pressure is 12 to 16 mm Hg. Anything more than 25 mm Hg is Pul Hypertension. It is measured by rt heart catheterization and not by echo which measures RVSP which is not a correct measure of pul artery pressure.

Seretide and seroflo are two different brand names both containing same medicine ie long acting beta agonist and long acting steroid. They have slight adv over budecort and they are same as esiflo.I do not know the composition of maxflo, hence cannot comment but i`m sure it may also be same. I personally feel that seretide is better than others because of mechanism of drug delivery. Your wife may try it.

She can continue Tiova.

At present there is no need for any medicine for pul hypertension.

FEV1 will improve as her symptoms are controlled.

Oxygen saturation is normal.

In your first query you had mentioned that her TMT was mildly positive. Consult a cardiologist for it.

I hope i have been able to answer your queries.

Take care.
Above answer was peer-reviewed by
 
Follow-up: Breathlessness, tiredness, giddiness, pedal oedema. Have chronic asthma and palpitations. Advice? 15 hours later
Dear Dr XXXXXXX

Profuse thanks to you for enlightening on the disease & medication. No other Dr in Chennai /Bangalore has diagnosed so well , that too without seeing the patient & ALL reports . Only One Cardiologist of Gangaram Hospital Delhi ( Dr Sawhney ) was clear after seeing the patient & all reports .
We continue to be quite worried as some Doctors in Chennai & Bangalore had told that she has clinical right heart failure ( Although All echo reports show normal size RA & RV , barring only one Echo during admission showed mild dilatation of RA & RV )
Pulmonary Angiogram on the day of admission showed NORMAL pulmonary arteries.

Myself & my wife are likely to be in Delhi for 1 or 2 days during 1st week of Sept .
I am keen to consult you in case you are available for consultation.
We would be fortunate if you could kindly see her at your Delhi clinic.
May I have your clinic adress & phone no .
I will inform our date of Delhi visit few days in advance.

Warm regards


XXXXXX
 
 
Answered by Dr. Shashi Dangwal 5 hours later
Hi XXXXXXX

Thanx for your remarks. Most certainly you can see me during your visit to Delhi. My clinic address and phone no. are given below:

Arcus Polyclinic, 2nd floor, Central Market, Dwarka, New Delhi 0000

My mob. 0000

Regards.
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