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Suggest treatment for COPD

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Posted on Mon, 29 Sep 2014
Question: This relates to pulmonology and COPD. I smoked for 30 years and now have COPD. I had gone back to smoking before I knew. (First diagnosed as mild) Now that I quit I feel much, much worse and my FEV1 varies all over the place from bad to close to normal. (I have a portable spirometer). My sob went from minimal to very heavy lungs and more sob, less energy. I don't understand how quitting could make this go from minimally felt to this degree of damage. Have not been to doctor. Please any opinions, and will I ever feel better from quitting?
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Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:
COPD treatment is multimodality treatment.

Detailed Answer:
Hi XXXX myself Dr. Kaushal Bhavsar. I am practising pulmonologist in XXXXXXX XXXXXXX XXXXXXX Thanks for your question on HCM. Hope my answer will help you. Since you are smoker and age more than 40 years there is likelyhood of COPD more. But I will still suggest to consult pulmonologist and get done full Pulmonary Function Test (PFT) and Chest X ray. Both these are needed for not only diagnosis but also for staging (severity) of COPD. There is GOLD guidlenes for diagnosis and management of COPD. The treatment is combination of below mentioned modalities.
1. Smoking cessation is the fundamental principle in treatment.
2. Enroll to pulmonary rehabilitation center where they will teach you chest physiotherapy and breathing exercise.
3. Start inhaled therapy with bronchodilators like long acting beta 2 agonist, inhaled corticosteroids and anticholinergic according to severity.
4. Plan for respiratory vaccines like pneumococcal and influenza.
These all treatment are needed for better control of COPD. Simply smoking cessation will not help you in terms of full treatment. You need other above mentioned things with smoking cessation for complete COPD treatment. And with proper treatment and regular follow up you can control your COPD and live normal active life and definitely you will feel better.
For all these you need to consult pulmonologist first and discuss these things with him.
Hope I have solved your query. If you have any further questions I will be happy to help. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Follow up: Dr. Kaushal Bhavsar (8 hours later)
Thank you for your detailed response. I should have mentioned that i am on Advair and have seen a pulmonologist. At the time i was mild and felt fine. Went back to smoking and quit a week ago. My main question was (is) : is it normal to feel so much worse after quitting? My lungs hurt, i am much more sob, much less energy, my portable spirometer (just for fev1) has my fev1 dropping 20 points lower than just a few days ago. I don't have an infection. Thanks.
doctor
Answered by Dr. Kaushal Bhavsar (28 minutes later)
Brief Answer:
it is withdrawal symptoms more likely.

Detailed Answer:
Hi XXXX thanks for your reply on HCM.

Advair contains fluticasone. Is it so? In my opinion you should start combination treatment in the form of long acting beta 2 agonist with inhaled corticosteroids and anticholinergic. And I suggest MDI (Meter dose Inhaler) with spacer device. Ask your doctor about this. He will explain the proper technique.
About variation in FEV1, it is possible to have 20-30 variation in test since PFT is effort dependent test. And variation is also having diurnal changes(changes with day and night). So no need to worry about 20 variation in FEV1.

And about your symptoms of less energy, I think it is just a withdrawal symptom. It is quite common to have withdrawal symptoms after long habit of 30 years. So try to cope with it. And if you find difficulty in this, nicotine gums are available. Ask your doctor about it for dosing and duration.

Hope I have solved your query and I will be happy to answer further queries if you have. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Kaushal Bhavsar (2 hours later)
Thank you very much. That is very helpful. I will talk to my doctor.
doctor
Answered by Dr. Kaushal Bhavsar (13 minutes later)
Brief Answer:
satisfaction regarding your question.

Detailed Answer:
Hi XXXX, if you feel I have solved all your queries please close the discussion and answer.And I will be happy to answer your other queries. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Kaushal Bhavsar (2 hours later)
One more: i know you need to see the xray but the cxr itgey did recently showed hyperinflated lungs and white space in one part of lower lungs, not upper. Can one have both lowerr and upper? Lower is much worse?
doctor
Answered by Dr. Kaushal Bhavsar (13 minutes later)
Brief Answer:
answer related to chest x ray query.

Detailed Answer:
Hi XXXX, sorry to say but I can't get what you are saying. I can understand hyperinflated lungs and it is common in COPD patients. But I can't get the white thing , you are mentioning in lower part of lung. It will be better, if you send me image of your x ray. Normally bronchovascular markings are more in lower lung because of gravity dependent more blood supply of lower lungs. So lower part of chest x ray looks slightly more white than upper part. Need chest x ray to understand your query. Hope you finds your answer.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14643 Questions

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Suggest treatment for COPD

Brief Answer: COPD treatment is multimodality treatment. Detailed Answer: Hi XXXX myself Dr. Kaushal Bhavsar. I am practising pulmonologist in XXXXXXX XXXXXXX XXXXXXX Thanks for your question on HCM. Hope my answer will help you. Since you are smoker and age more than 40 years there is likelyhood of COPD more. But I will still suggest to consult pulmonologist and get done full Pulmonary Function Test (PFT) and Chest X ray. Both these are needed for not only diagnosis but also for staging (severity) of COPD. There is GOLD guidlenes for diagnosis and management of COPD. The treatment is combination of below mentioned modalities. 1. Smoking cessation is the fundamental principle in treatment. 2. Enroll to pulmonary rehabilitation center where they will teach you chest physiotherapy and breathing exercise. 3. Start inhaled therapy with bronchodilators like long acting beta 2 agonist, inhaled corticosteroids and anticholinergic according to severity. 4. Plan for respiratory vaccines like pneumococcal and influenza. These all treatment are needed for better control of COPD. Simply smoking cessation will not help you in terms of full treatment. You need other above mentioned things with smoking cessation for complete COPD treatment. And with proper treatment and regular follow up you can control your COPD and live normal active life and definitely you will feel better. For all these you need to consult pulmonologist first and discuss these things with him. Hope I have solved your query. If you have any further questions I will be happy to help. Wish you good health. Thanks.