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Suggest Treatment For Asthma And Breathing Difficulty
Question: My daughter is 14, has been to an ENT,allergy &asthma specialist, and after months of various meds has fixed her asthma (breathing out) but still has difficulty breathing in & feels she can't catch her breath. What can we do to systematically eliminate the remaining potential causes & help her breathe? She is getting very frustrated as 3 doctors have not been able to solve the problem. We are getting concerned it may be something more serious. Should we be concerned?
Brief Answer:
She will require further evaluation.
Detailed Answer:
Hi,
Thank you for your query.
1. An X-ray Skull lateral view and a nasal endoscopy (or a Sinus CT Scan) will help rule out any adenoid hypertrophy or nasal obstruction (deviated nasal septum, hypertrophied nasal turbinates, sinusitis).
2. Does she have snoring or mouth breathing at night? Has she ever woken up from sleep with breathlessness? Does this happen throughout the day, even when she is busy? Is she able to participate in sports?
3. I am assuming that her lung function test, cardiac tests and blood tests have been done.
4. You are giving her medication for asthma, allergy and reflux.
5. It is possible to test for allergy with skin prick tests (SPT) and blood tests (IgE and IgG based). Thereafter desensitization may be attempted.
6. Upload the results of these tests for further treatment options.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
She will require further evaluation.
Detailed Answer:
Hi,
Thank you for your query.
1. An X-ray Skull lateral view and a nasal endoscopy (or a Sinus CT Scan) will help rule out any adenoid hypertrophy or nasal obstruction (deviated nasal septum, hypertrophied nasal turbinates, sinusitis).
2. Does she have snoring or mouth breathing at night? Has she ever woken up from sleep with breathlessness? Does this happen throughout the day, even when she is busy? Is she able to participate in sports?
3. I am assuming that her lung function test, cardiac tests and blood tests have been done.
4. You are giving her medication for asthma, allergy and reflux.
5. It is possible to test for allergy with skin prick tests (SPT) and blood tests (IgE and IgG based). Thereafter desensitization may be attempted.
6. Upload the results of these tests for further treatment options.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. She has a deviated septum but has not had a sinus CT scan nasal endoscopy although ENT doc put scope through her nose and looked down her throat unless that is the same thing. Even so im thinking logically she could alternatively breath in through her mouth.
2. No snoring or wheezing at night. She never has awakened from sleep breathless as far as I kmow. It happens all the time duringnthe day when she is busy and when she is relaxing, sitting on the bus listening to music. She can participate in sports but has lost breath and asked to be removed and has to sit out. She played school & travel soccer, ran cross country and did very well until the end of the fall season where she couldnt get breath & fell behind to last place. She says she feels better with cold than warm air inside air conditioning is better at 68F or colder.
4. Her lung function increased from 73% in January this year to well over 120% now after asmtha tests & has tested OK several times after ER visits & nebulizer doesnt help at all. What cardiac & blood tests should we do & for what? She has had a battery of allergy tests & is allergic to many things except our dog & is the cause of the asmtha. My wife now deceased but had exercise induced asthma & allergies to dust & mold. I had very bad hay fever but grew out of it. My wife was adopted & found out her birth father had some mass removed from his lung and was we think was benign. My father had an esophogus condition but not sure if either is hereditary. My wife died of unrelated appendiceal cancer.
4. Yes. Asmtha under control so we backed off many meds but she feels some were helping so reinstated prilosec now & may speak to doc about others.
5. Skin prick tests done so allergies are known. Desisitization cant be done until afterallergy season according to doc but are planned at some point.
Any further thoughts based on above information?
2. No snoring or wheezing at night. She never has awakened from sleep breathless as far as I kmow. It happens all the time duringnthe day when she is busy and when she is relaxing, sitting on the bus listening to music. She can participate in sports but has lost breath and asked to be removed and has to sit out. She played school & travel soccer, ran cross country and did very well until the end of the fall season where she couldnt get breath & fell behind to last place. She says she feels better with cold than warm air inside air conditioning is better at 68F or colder.
4. Her lung function increased from 73% in January this year to well over 120% now after asmtha tests & has tested OK several times after ER visits & nebulizer doesnt help at all. What cardiac & blood tests should we do & for what? She has had a battery of allergy tests & is allergic to many things except our dog & is the cause of the asmtha. My wife now deceased but had exercise induced asthma & allergies to dust & mold. I had very bad hay fever but grew out of it. My wife was adopted & found out her birth father had some mass removed from his lung and was we think was benign. My father had an esophogus condition but not sure if either is hereditary. My wife died of unrelated appendiceal cancer.
4. Yes. Asmtha under control so we backed off many meds but she feels some were helping so reinstated prilosec now & may speak to doc about others.
5. Skin prick tests done so allergies are known. Desisitization cant be done until afterallergy season according to doc but are planned at some point.
Any further thoughts based on above information?
Brief Answer:
Details are discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. A DNS (Deviated Nasal Septum) can cause problems breathing in. Breathing through the mouth causes dryness and the air cannot be cooled and humidified as through the nose. That is why she feels better in cold air or an air conditioned environment, yet still has the discomfort. The ideal age for correction of DNS is after her face growth is complete, unless it is severe. However adenoids and turbinates can be reduced immediately to help her cope up.
2. There may be an element of reflux due to the asthma, steroids and anti-asthma drugs. I would add a gut motility enhancer (prokinetic) such as levosulpiride or cinitapride.
3. The Sinus CT should be done. Get a Videolaryngoscopy (VL'Scopy) done. Otherwise add a Neck & Chest CT with a virtual endoscopy. Upload the images and video.
4. The cardiac tests should include an ECG and 2D Echo to rule out any cardiac related cause. Blood tests for allergy are an alternative to skin prick tests.
5. Your allergy assessment and treatment seems to be on the right track. Exercise induced asthma may be involved.
6. What asthma medications and nebulisation (which is not effective) does she receive in the ER? This may give clue if the obstruction is higher up or lower down in the airway.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Details are discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. A DNS (Deviated Nasal Septum) can cause problems breathing in. Breathing through the mouth causes dryness and the air cannot be cooled and humidified as through the nose. That is why she feels better in cold air or an air conditioned environment, yet still has the discomfort. The ideal age for correction of DNS is after her face growth is complete, unless it is severe. However adenoids and turbinates can be reduced immediately to help her cope up.
2. There may be an element of reflux due to the asthma, steroids and anti-asthma drugs. I would add a gut motility enhancer (prokinetic) such as levosulpiride or cinitapride.
3. The Sinus CT should be done. Get a Videolaryngoscopy (VL'Scopy) done. Otherwise add a Neck & Chest CT with a virtual endoscopy. Upload the images and video.
4. The cardiac tests should include an ECG and 2D Echo to rule out any cardiac related cause. Blood tests for allergy are an alternative to skin prick tests.
5. Your allergy assessment and treatment seems to be on the right track. Exercise induced asthma may be involved.
6. What asthma medications and nebulisation (which is not effective) does she receive in the ER? This may give clue if the obstruction is higher up or lower down in the airway.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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