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Asthma, wheezing, anxiety, treatment and precautiions - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Asthma and Allergy
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   I am a 33 year old feXXXXXXXXe. I have severe asthma. I have been having massive attacks since late December and hospitalized 3 times for exaserpation. I have been to the ER about 5 times, most recently, on Monday, sent by my PCP. I am on a back-up tank of oxygen that my Mom happened to have on hand right now. My nebulizer isn't helping. My chest is burning in my sternum area and I am wheezing. My family can't continue to take time off to take me to the ER and my sister is in labor at a hospital about 30 minutes away. Can you please advise? Thank you!
Doctor :   Hi
Doctor :  
Let me read it
Doctor :   Ok

User :   Obviously, I'm trying to avoid going to the ER right now. No massive attack right at the moment, but I'm struggling.
Doctor :   Ok

User :   (Thank you, by the way, for your assistance!)
Doctor :  
Right now, the problem you are having is with wheezing?
User :   Yes. Burning chest pain and bad night sweats.
Doctor :   Ok

Doctor :  
Yes, at night due to the gravitational changes, and due to the pressure from the diaphragm
Doctor :  
breathing becomes more difficult
User :   Right. It usually is for me.
Doctor :  
You should not keep your head down while aslee
Doctor :  
you should maintain an inclination at your head end
User :   I'm propped up with pillows right now.
Doctor :  
till you are fine
Doctor :  
ok, that is good
Doctor :  
but do certain changes
Doctor :  
and next comes the nebulizer
User :   Okay
Doctor :  
may I know which medication is used in the nebulizer as of now?
User :   Albuterol
User :   I'm on SEVERAL medications.
Doctor :  
User :   But albuterol in my nebs.
User :   Puffer doesn't work at all.
Doctor :  
Could you elaborate on that along with the dosage and frequency?
User :   Sure, one second.
Doctor :   other medications as well

User :   Prempro -- .625mg - 2.5mg -- AM and PM
User :   Levothyroxine -- 50mcg -- AUser :   Acyclovir -- AM and PM
Doctor :   ok

User :   400mg Acyclovir, sorry
User :   Sertraline 100mg -- AM and PM
User :   Gabapentin 800mg -- AM and PM
User :   Lamotrigine 300mg -- AM and 200mg PM
Doctor :  
User :   Diazepam 10mg -- 4X Daily
User :   Ondansetron 4mg -- PRN
User :   Ambien 10mg -- PM
User :   Multi-Day Vitamin
User :   Calcium Citrate + Vitamin D
User :   And Z-Pack right now.
User :   Oh, and Singlair, 10mg (I believe)
User :   And Flovent 1 puff AM and PM
User :   (Those last 3 are new).
Doctor :   Ok

Doctor :  
What is that Singlair?
User :   Singulair
User :   I think I mispelled it by accident.
Doctor :   Fine

Doctor :   Now first thing is that, the list is very exhaustive
User :   I know, I apologize.
Doctor :  
and also are they all seperate medications
User :   Yep
Doctor :  
or are there any combinations as well?
Doctor :  
so there is more than asthma in your case
User :   No, except the Diazepam is for my anxiety and to bring me out of my epileptic seizures.
User :   Yes... a lot
Doctor :   ok
Doctor :  
but thyroid as well
User :   Epilepsy, Bi-Polar II, PTSD, Thyroid, recent ASD closure
User :   Anxiety, Insomnia, von Willabrand's Disease
Doctor :   Right

User :   Total Hysterectomy due to bad Endometriosis
Doctor :  
There shall be cross interactions b/w these drugs
User :   Okay
Doctor :   that should be considered

User :   After the asthma attacks, and right now, I have terrible headaches from the coughing, etc. I need something for pain, but I am accused of drug-seeking behavior.
Doctor :   You are on many medications which does improve pain

User :   I don't want to go home with any pain meds, just treated for the pain in the ER so that I'm comfortable.
Doctor :  
ex Gabapentin, Diazepam and Lamotrigine
User :   They have me try the breathing treatments (several in the ER), which help me breathe. They give me Adavan via IV, which I don't feel at all.
User :   I only experience the pounding pain after the attacks.
User :   Again, this is all since December.
Doctor :   Ok

Doctor :  
Has there been any change in medications in the last 3 months?
User :   In the hospital, last Tuesday - Wednesday and again Thursday - Saturday, I was given Dilaudid every hour or so on doctor's orders.
User :   Yes, we up'd my Lamotrigine to 300mg in the AM because my seizures were out of control.
User :   They're doing well now.
User :   In December when I was hospitalized for this, I had several grand XXXXXXXX seizures and lactic acidosis.
Doctor :   Ok

User :   A pulmonologist worked with me on that visit. The other 2, just a doctor on rounds.
User :   I don't have a pulmonologist right now, but I have an appointment as a new patient on Monday,.
User :   When my PCP sent me over from her office on Monday for my attack, she suspected that I was released from the hospital for the asthma way too soon.
Doctor :   Ok

Doctor :   Now the option left for you

User :   Okay
Doctor :  
is to consider the change in dosage of nebulization
Doctor :   and also the frequency

Doctor :  
that is the one which can bring faster and better relief
User :   Okay. Been using up to 4-6 nebs a day, as needed, as per instructions on the vial box.
User :   I avoid them if I can.
Doctor :   For instant control during such exacerbations

Doctor :  
nebulizers are inevitable option
User :   I agree, completely.
User :   I do my best with them. It's difficult to stay calm too, but I try to slow down and breathe.
Doctor :   Ok

User :   Question: why the night sweats and chest pain?
Doctor :   Can I ask you about your habits?

User :   Sure, go ahead.
Doctor :   Do you smoke?

User :   NEVER
Doctor :   Ok

User :   I've never smoked, drank, nor used drugs of any kind in my life.
Doctor :  
The common triggers are smoke, allergens like pollen, certain medications
User :   I avoid smoke and smokers completely.
Doctor :  
dust mites, aniXXXXXXXX dander, cockroaches, certain odors and sprays as well
User :   My family suspects there may be mold in my apartment?
User :   Dander kills me.
Doctor :   Yes molds do cause

User :   I have only seen ants in my apartment, occasionally. I try to use environmentally friendly cleaners, but I can't avoid all cleansers.
Doctor :   True

Doctor :  
but you should be extracareful
User :   I dust everything at least once a week, including my ceiling fan.
User :   I don't use candles.
Doctor :  
I shall send you a brochure which elaborates on controlling asthma symptoms within the next 24 hours
Doctor :  
wherein you can get all the required knowledge to help
User :   Sounds good.
User :   What should I do in the short-term? If it gets to be too much, back to the ER?
Doctor :   I would suggest you to try pursed lip breathing during acute attacks

Doctor :  
Cough out as much mucus as you can into tissue paper
User :   I do that.
Doctor :  
this will loosen the mucus that is accuXXXXXXXXated in the air ways
User :   It's mostly clear, with a little yellow color.
Doctor :   also you will need a medication during acute attack
User :   I always seem to cough up stuff.
Doctor :  
Do discuss it with the docto
User :   I will, for sure.
Doctor :  
yes coughing out is a good habit
Doctor :   Practise relaxed breathing

User :   I meditate every day. I try to during an attack, but I get scared and lose focus.
Doctor :   Ok

Doctor :  
let me explain you about relaxed breathing
Doctor :  
Sit in a chair comfortably
User :   These attacks are instant. Nothing necessarily brings it on, like a cold, lately.
User :   Okay, gotcha.
Doctor :   Ok

Doctor :   Relax your shoulders and neck

Doctor :  
shall I continue to explain about it?
Doctor :  
or are you aware of it?
User :   That's hard. That's where I carry all my stress. My work is all computer analysis.
Doctor :   Ok

Doctor :  
But you should consider it
Doctor :  
for betterment of symptoms
User :   What does the relaxation of the shoulders and neck help?
User :   Okay, I am wheezing a lot now.
Doctor :  
it reduces the mental tension as well
User :   I am sitting up.
Doctor :   Ok

Doctor :  
If you are not able to chat
Doctor :  
we can end it
Doctor :  
I shall send you the brochure
User :   I can type, can't speak.
Doctor :   ok

User :   Should I start a breathing treatment?
Doctor :  
Breathe in slowly through your nose.
Doctor :  
Sure it does help
User :   Exhaling is where the wheezing sound is.'
Doctor :  
Doctor :  
it happens due to constriction of the airways
User :   Okay
Doctor :  
what is the medication you have advised to take during acute attacks?
User :   Start with an albuterol puffer... Proventil. Does nothing.
Doctor :   But you should do it

User :   Then I use albuterol vials in my nebulizer.
Doctor :  
there is medical evidence
User :   Okay, just did 2 puffs.
Doctor :  
How about salbutamol?
Doctor :  
Have you tried it before?
User :   Not prescribed that.
User :   I think they've given it to me in the hospital.
Doctor :  
Doctor :  
that is more potent in some patients
User :   Okay
Doctor :  
and has better response
Doctor :  
so do talk about that as well with your doc
User :   Will do.
User :   I get shaky from the nebs. Should I take one of my
User :   Valium?
Doctor :   Have you been allowed or prescribed to do so?

User :   I'm on a maintenance dosage of 10mg up to 4x daily.
User :   I try not to take it.
Doctor :   Ok

Doctor :   For now stay relaxed and use breathing with pursed lips

Doctor :  
while breathing out especially
User :   Okay
Doctor :   Is there any thing else I can help you with?

User :   Just one question...
Doctor :   Sure
User :   Should I wait if I wake up with this again? Wheezing, bad chest pain and severe sweating?
User :   That's what happened to me tonight.
Doctor :   You should go to ER

Doctor :  
should not be left alone
User :   Okay. I understand.
User :   Any idea why I'm getting the severe sweating?
Doctor :   With breath problems, there shall be sweating

Doctor :  
both are interrelated
User :   Okay, I get it.
User :   :)
Doctor :   Please fill the feedback form say done when done.

User :   Done.
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User :   Thanks so much, again!
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