Suggest treatment for bronchial spasms, wheezing and cough
Likely to be allergic asthma, further evaluation needed
Hello and Welcome
I appreciate your concern
The symptomatic treatment with advair and the cough syrup would have resulted in some degree of improvement and stability till now. Further evaluation is required. If the physical exam does not reveal anything serious then the dose of the advair can be increased and spirometery can be advised to look for a diagnosis of asthma which is an airway disease involving hyper reactivity of the airways. Patients can be allergic to a specific allergen and that should be avoided along with medications like inhaled corticosteroids/beta agonists/LTR antagonists for treatment and prevention. If asthma is diagnosed and the advair alone is not leading to remission of flares or the flares are recurrent then LTR antagonists like montelukast can be added for long term benefit. Upon assessment if there is severe wheezing , pulse oximetery and ABGs should be done. Fever should be checked and an X ray chest be ordered to look for other suspected causes. You mentioned a viral infection, if such viral infections dont resolve then they can be followed by superimposed bacterial Lower respiratory chest infections. She should be assessed for requiring antibiotics if the need be.
In short, this condition needs further assessment especially since advair isn't helping her. I will recommend she consults a chest physician.
Wishing you best of health
Please consult your doctor before deciding on any further course of action.
Dr. M.S. Khalil
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