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Intermittent chest pain, breathing difficulty with heavy cough. Temporary relief with medicines. Complete remedy?

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Pulmonologist
Practicing since : 2003
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Hi Doctor,

Myself XXXXXX. My sister has been suffering from breathing and chest pain, off and on from a long time (since September 2009) .
We consulted few doctors and they had given some antibiotics & medicines and could see some relief but not completely cured.
These days she is getting Sevier chest pain and breathing problems and she gets heavy cough during the pain.
Whenever she faces this problem we are giving NEBULISER(DR. MOREPEN) using medicine levolin 0.63mg (respules).
We will give one or sometimes 2 respules based on her situation.
Note: She had been using FLIXONASE nasal spray almost 2 ½ yrs. every day twice (morning and night). She stopped the using from last 4 months.

Could you please let us know how can she get rid of from this problem completely?
Also would like know if there is any diet restriction for the same.

Thanks in advance.
Posted Fri, 7 Jun 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 47 minutes later
Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1.Your sister needs to get herself evaluated with a Pulmonologist.

2. She seems to be suffering from allergic rhinitis with bronchial asthma or ?post nasal drip (Upper airway cough syndrome).

3. Investigations required are chest xray, Xray paranasl sinuses, serum Ig E levels and PFT(Pulmonary function tests).

4. From the medications that you have taken the following can be continued along with current medications(nebulisation to be taken only when breathlessness is not controlled with these medications).
FOMTODE MDI with spacer 200 2-0-2 Daily – Gargle after use.
Inhaler – Duolin 1 puff 5 to 6 times a day and as and when required.
FLIXONASE (twice a days on waking and at bed time)
Montair LC 0-0-1 at bed time
TAB PANTODAC 40 1-0-0

5. A proper management target should be that there should be no need of nebulisation. Thus you need to get yourself evaluated with a pulmonologist and get your treatment titrated, as soon as possible.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Intermittent chest pain, breathing difficulty with heavy cough. Temporary relief with medicines. Complete remedy? 41 minutes later
Hi Doctor,

Thank you verymuch for your quick response.

1) But observed that when she uses the Inhaler – Duolin, she does not feel better/comfort and seen conditoin becoming worse so she stopped completely using the same 2 yrs back and later she did not use any inhalers.

1) My main concern is, when she is alone or gone for out how should she handle this problem? Can you please suggest any alternative inhaler which could provide quick relief as we cant accompany her always.

2) As of now we are mainly depending on nebulization (levolin 0.63mg), whenever she feels breathing and/or chest pain issue. will there be any side affects if we use this medicine frequently or if we continue further?

3) I'm staying at Yelahanka New Town, Bangalore - 0000. Karnataka.
Can you please suggest some Pulmonologist near by my place.

4) Any diet restrictions?
5) Are there any home remedies that we can follow regularly?

Thanks in advance.

Thanks and Regards,
XXXXXX
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for the follow up.

1. The inhaler has to be taken with a spacer (eg: transpacer V) with correct technique. If the technique is incorrect then there is less or no effect.

2. Duolin is a reliever medicine and cannot be taken on a long term basis as it will not prevent airway remodelling. You need to take a maintenance inhaler also. Long term nebulisation is normally not advocated except in certain exceptional cases.



I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
3. Salbair I/ duolin inhaler can be used as an emergency inhaler for travels and formonide/budamate inhaler can be used as a maintenance inhaler.

4. Avoid spicy diet, cold drinks, any thing directly out of the refrigerator.Avoid any form of dust exposure.

5. Do consider flu and pneumococcal vaccine for her.

6. Proper medications alone is very improtant along with avoidance of triggers as mentioned above.

5. List of pulmonologist in Bangalore:
WWW.WWWW.WW
Above answer was peer-reviewed by
 
Follow-up: Intermittent chest pain, breathing difficulty with heavy cough. Temporary relief with medicines. Complete remedy? 13 hours later
Hi Doctor,

Thank you for the reply.

Today she is feeling very tired. After taking food she is feeling very tired. Not able to stand.

Night we have given her Montair LC and this morning Nebulization one time.

Please suggest me the next steps.
Thanks in advance.

Thanks and Regards,
XXXXXX.
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for the follow up.

1. She needs to be evaluated in detail for other diseases and investigated on the lines as mentioned in previous posts.

2. Please get her evaluated with a Pulmonologist as soon as possible.

3. Meanwhile continue nebulistaion 4 hourly till doctor's visit and also tb. ABphylline 100 mg twice a day can be started.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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