Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Wheezing And Asthma
Question: I have been suffering from wheezing and asthma since a decade. The condition gets aggravated in cold and windy climates. I do get asthma attacks frequently at night and after having lunch also. I have been taking levo-salbutamol inhaler and fluticasone+salmetrol powdered rotacaps SOS. Recently i have been taking monteleukast and levocetrizine combination tablet as an when required and otrivin drops for nasal congestion (daily), which makes me feel drowsy for the whole day. Kindly let me know if any treatment can be done for the same as it becomes quite distressing for me, at times. Additionally i am non smoker and do not use any tobacco products, neither i drink.
Brief Answer:
Regular inhalers, allergy testing, life style changes
Detailed Answer:
Hello,
Thank you for asking at HCM.
I went through your history and would like to know more about you as follows:
a. Since how long are you using Fluticasone+Salmeterol via rotacaps? What is the strength? How frequently in a day? Are you taking it regularly or irregularly?
b. How frequently do you use Montelukast & Levocetirizine and Otrivin?
c. Do you have any other allergies, for example, skin allergies?
d. Do any particular foods aggravate your respiratory complaints?
e. Does anyone from your family members have allergies or asthma?
f. May I know your occupation? Are you regularly/routinely exposed to smokes/dusts/air pollutants in job/home/environment?
g. You have mentioned about migraine and amytriptyline and propranolol. Do you have any other medical condition/s? Do you need to take any other medications on frequent/regular basis?
h. Is stress an important factor in your life? Does it aggravate asthma?
Above information would help me to understand your complaints better. Please provide these details on follow-up. It will be my humble pleasure to help you with best of my knowledge and experience.
At present, I would make suggestions as follows (from your given information):
1. Were I treating you, I would suggest you daily montelukast + fexofenadine, before going to bed. This combination will cause less sedation.
It is helpful for both nose allergies and asthma.
2. I would suggest you to take Fluticasone+Salmeterol rotacaps on regular basis, not on SOS basis. This combination works best when it is used regularly. If you still have asthma attacks, you can use levosalbutamol rotacaps on SOS basis.
Please make sure that Fluticasone+Salmeterol combination is for regular use and Levosalbutamol is for SOS use. Please do not have confusion between them.
3. I would also like to review your technique of using rotacaps. If it is not perfect, it is possible that necessary amount of drug might not reach lungs. In that case, using Metered Dose Inhaler with Spacer Device might be a better option than Rotahaler.
4. I would suggest you allergy testing for air borne allergens such as house dust mites, molds, pollens etc. This will help you identify the substances causing allergies to you and also to know how to avoid them.
Based on allergy testing, an Allergist-Immunologist may prescribe you allergen specific immunotherapy which gradually improves your symptoms.
5. Regular Yoga & Pranayama will also help you to improve your immunity and lung capacity respectively.
6. Please have a nutritious diet rich in vitamins, minerals and antioxidants. This is important for better immunity.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Regular inhalers, allergy testing, life style changes
Detailed Answer:
Hello,
Thank you for asking at HCM.
I went through your history and would like to know more about you as follows:
a. Since how long are you using Fluticasone+Salmeterol via rotacaps? What is the strength? How frequently in a day? Are you taking it regularly or irregularly?
b. How frequently do you use Montelukast & Levocetirizine and Otrivin?
c. Do you have any other allergies, for example, skin allergies?
d. Do any particular foods aggravate your respiratory complaints?
e. Does anyone from your family members have allergies or asthma?
f. May I know your occupation? Are you regularly/routinely exposed to smokes/dusts/air pollutants in job/home/environment?
g. You have mentioned about migraine and amytriptyline and propranolol. Do you have any other medical condition/s? Do you need to take any other medications on frequent/regular basis?
h. Is stress an important factor in your life? Does it aggravate asthma?
Above information would help me to understand your complaints better. Please provide these details on follow-up. It will be my humble pleasure to help you with best of my knowledge and experience.
At present, I would make suggestions as follows (from your given information):
1. Were I treating you, I would suggest you daily montelukast + fexofenadine, before going to bed. This combination will cause less sedation.
It is helpful for both nose allergies and asthma.
2. I would suggest you to take Fluticasone+Salmeterol rotacaps on regular basis, not on SOS basis. This combination works best when it is used regularly. If you still have asthma attacks, you can use levosalbutamol rotacaps on SOS basis.
Please make sure that Fluticasone+Salmeterol combination is for regular use and Levosalbutamol is for SOS use. Please do not have confusion between them.
3. I would also like to review your technique of using rotacaps. If it is not perfect, it is possible that necessary amount of drug might not reach lungs. In that case, using Metered Dose Inhaler with Spacer Device might be a better option than Rotahaler.
4. I would suggest you allergy testing for air borne allergens such as house dust mites, molds, pollens etc. This will help you identify the substances causing allergies to you and also to know how to avoid them.
Based on allergy testing, an Allergist-Immunologist may prescribe you allergen specific immunotherapy which gradually improves your symptoms.
5. Regular Yoga & Pranayama will also help you to improve your immunity and lung capacity respectively.
6. Please have a nutritious diet rich in vitamins, minerals and antioxidants. This is important for better immunity.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Hello sir,
1. I have been taking Esiflo 250 (Lupin Pharma); salmetrol 25 mcg and fluticasone at 250 mcg. It was started in middle of 2008 when my condition deteriorated in XXXXXXX and Budesonide which was started in early 2008 stopped working. My thrombocyte count was towards higher side during that time. I was asked to use Esiflo regularly thrice daily initially but after around 4 months, the doctor advised me to switch to salbutamol inhaler (Asthalin) and use Esiflo in SOS. Nowadays i am more reliant on L-Salbutamol and hardly use Esiflo.
2. I have been using Monteleukast + Levocetrizine since past one year. In the current weather of XXXXXXX i use that only when i have rhinitis and severe wheezing. Usually 1-2 tablets in a week. I use Otrivin regularly since i do have nasal blockades usually during bed time. Previous i have tried Fluticasone nasal spray as well as Azelastine nasal spray but even after full therapy, the symptoms returned. Sometimes, when i get fever and cold, ieeay yellowish-greeny looking mucous/sputum coming out and i feel relieved.
Actually after using Fluticasone+ Salmetrol on a regular basis, i started gaining weight rapidly, i.e. abdominal and facial obesity. Though i had cut down much on food, still condition persisted. Presently i weigh 86 Kgs at 5.11 height. Since i bought this to the physician notice way back, he cut down on my Esiflo use. I am totally fine during summer season and hardly ever have asthma attacks or rhinitis. My condition aggravates in XXXXXXX but when i go to native in XXXXXXX i become symptom free.
3. My father has been an asthamatic in my family, but for him too its seasonal, though he easily manages on salbutamol. But for me the condition is even worse. Though i wear warm clothes and totally avoid any cold items, i still get attacks at night. Also i ride on bike for 15 kms every day in the polluted bagalore roads totally wearing jackets and woolens.
Kindly suggest the further course of treatment.
Regards,
XXXX
YYYY@YYYY
Hello Sir,
Additionally, i do not have any skin related or other allergies and till date i have not taken any other medications for any underlying cause.
My migraine has recovered years back and presently i do not take any medications for migraine. Probably it was sinus pain which the doctor wrongly diagnosed as migraine.
I have been allergic to cold food and even yoghurt in warm form also. i am a non- vegeterian but that does not effect me at all. I regularly go to gym and do cardio for 20 mins, thrice a week.
I am a Pharma professional and work in an IT company in Pharmacovigilance domain. Since office is AC so i am not exposed to pollution though i travel for 15 kms daily on bike.
I am not under too much stress so that factor is not that attributing. Earlier around 2008-2011, i used to wake up at night probably two-three times a week, with a bad asthma attack and there used to be throbbing pain in my upper chest region during that period and the attacks used to last for hours together. The following day, i used to feel lethargic and could hardly use the stairs even after taking steroids. I have been administered in the past Dexomethasone (1 ml)+ Deriphyllin (2ml) combination, which did provide me relief. But recently things have improved and i do not get painful asthma attacks and it is more of wheezing kind, which is quite frequent.
Regards,
XXXX
1. I have been taking Esiflo 250 (Lupin Pharma); salmetrol 25 mcg and fluticasone at 250 mcg. It was started in middle of 2008 when my condition deteriorated in XXXXXXX and Budesonide which was started in early 2008 stopped working. My thrombocyte count was towards higher side during that time. I was asked to use Esiflo regularly thrice daily initially but after around 4 months, the doctor advised me to switch to salbutamol inhaler (Asthalin) and use Esiflo in SOS. Nowadays i am more reliant on L-Salbutamol and hardly use Esiflo.
2. I have been using Monteleukast + Levocetrizine since past one year. In the current weather of XXXXXXX i use that only when i have rhinitis and severe wheezing. Usually 1-2 tablets in a week. I use Otrivin regularly since i do have nasal blockades usually during bed time. Previous i have tried Fluticasone nasal spray as well as Azelastine nasal spray but even after full therapy, the symptoms returned. Sometimes, when i get fever and cold, ieeay yellowish-greeny looking mucous/sputum coming out and i feel relieved.
Actually after using Fluticasone+ Salmetrol on a regular basis, i started gaining weight rapidly, i.e. abdominal and facial obesity. Though i had cut down much on food, still condition persisted. Presently i weigh 86 Kgs at 5.11 height. Since i bought this to the physician notice way back, he cut down on my Esiflo use. I am totally fine during summer season and hardly ever have asthma attacks or rhinitis. My condition aggravates in XXXXXXX but when i go to native in XXXXXXX i become symptom free.
3. My father has been an asthamatic in my family, but for him too its seasonal, though he easily manages on salbutamol. But for me the condition is even worse. Though i wear warm clothes and totally avoid any cold items, i still get attacks at night. Also i ride on bike for 15 kms every day in the polluted bagalore roads totally wearing jackets and woolens.
Kindly suggest the further course of treatment.
Regards,
XXXX
YYYY@YYYY
Hello Sir,
Additionally, i do not have any skin related or other allergies and till date i have not taken any other medications for any underlying cause.
My migraine has recovered years back and presently i do not take any medications for migraine. Probably it was sinus pain which the doctor wrongly diagnosed as migraine.
I have been allergic to cold food and even yoghurt in warm form also. i am a non- vegeterian but that does not effect me at all. I regularly go to gym and do cardio for 20 mins, thrice a week.
I am a Pharma professional and work in an IT company in Pharmacovigilance domain. Since office is AC so i am not exposed to pollution though i travel for 15 kms daily on bike.
I am not under too much stress so that factor is not that attributing. Earlier around 2008-2011, i used to wake up at night probably two-three times a week, with a bad asthma attack and there used to be throbbing pain in my upper chest region during that period and the attacks used to last for hours together. The following day, i used to feel lethargic and could hardly use the stairs even after taking steroids. I have been administered in the past Dexomethasone (1 ml)+ Deriphyllin (2ml) combination, which did provide me relief. But recently things have improved and i do not get painful asthma attacks and it is more of wheezing kind, which is quite frequent.
Regards,
XXXX
Brief Answer:
spirometry, allergy testing, immunotherapy, life style changes
Detailed Answer:
Hello Mr XXXX
Thank you for your follow-up and detailed information.
I would like to make suggestions for you as follows:
1. I usually suggest my such patients to use montelukast + levocetirizine regularly, especially during "bad" season.
As you feel sedated due to levocetirizine, I would suggest you to use montelukast + fexofenadine, as suggested previously, which causes less sedation.
Taking it in evening or before going to bed will even cause less sedative feeling.
Advantage is that monteluakst works for both upper airway (nose) and lower airway (lung airways), so it may reduce your regular inhaler requirement (such as Esiflo) in future.
2. I usually do not suggest my patients using nose drops such as Otrivin (decongestant drops) too often, usually not more than 3 days. As repeated use of such nose drops carries risk of a condition known as rhinitis medicamentosa. Which means patient gets rebound nose congestion upon stopping nose drops and after long time, such decongestants do not work for them.
So please do not use them too often for "opening" the nose.
3. I would also like to mention here that Esiflo is usually not advised for SOS use. Inhaled corticosteroids work best when they are taken regularly.
4. If there is any confusion regarding whether an asthmatic patient requires regular inhalers, I suggest them a test named Spirometry with post-bronchodilator reversibility.
It helps to know your lung capacity at present and the amount of airway obstruction with reversibility component. It can guide better whether you require SOS "rescue" type of inhalers or preventer type of inhalers.
5. As you have been prescribed propranolol previously, I would also like to mention that propranolol )beta blockers type of drugs) can worsen asthma at times, so make sure your doctor treating migraine is aware that you have asthma.
6. As mentioned previously, Allergy testing followed by immunotherapy (if indicated) will be helpful to you. Because immunotherapy is the only available treatment for allergy in medical science at present.
7. As mentioned previously, diet and life style changes (Yoga, Pranayama, Breathing exercises, stress reduction, etc) are very important to reduce medicine requirements.
8. In general, please avoid exposure to dusts, smokes and air pollution as much as possible. Of course, air pollution is a problem in XXXXXXX I usually suggest my patients personal protective devices like face mask, full helmet, etc to avoid exposure to harmful air particles.
9. Regular steam inhalation will help you in obstructive nose symptoms.
10. Obesity can also worsen asthma and reduce lung capacity. A weight loss as low as 5-10% of your current weight may be helpful to improve your asthma control. You may seek a professional guidance for diet and exercise plan for weight loss.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
spirometry, allergy testing, immunotherapy, life style changes
Detailed Answer:
Hello Mr XXXX
Thank you for your follow-up and detailed information.
I would like to make suggestions for you as follows:
1. I usually suggest my such patients to use montelukast + levocetirizine regularly, especially during "bad" season.
As you feel sedated due to levocetirizine, I would suggest you to use montelukast + fexofenadine, as suggested previously, which causes less sedation.
Taking it in evening or before going to bed will even cause less sedative feeling.
Advantage is that monteluakst works for both upper airway (nose) and lower airway (lung airways), so it may reduce your regular inhaler requirement (such as Esiflo) in future.
2. I usually do not suggest my patients using nose drops such as Otrivin (decongestant drops) too often, usually not more than 3 days. As repeated use of such nose drops carries risk of a condition known as rhinitis medicamentosa. Which means patient gets rebound nose congestion upon stopping nose drops and after long time, such decongestants do not work for them.
So please do not use them too often for "opening" the nose.
3. I would also like to mention here that Esiflo is usually not advised for SOS use. Inhaled corticosteroids work best when they are taken regularly.
4. If there is any confusion regarding whether an asthmatic patient requires regular inhalers, I suggest them a test named Spirometry with post-bronchodilator reversibility.
It helps to know your lung capacity at present and the amount of airway obstruction with reversibility component. It can guide better whether you require SOS "rescue" type of inhalers or preventer type of inhalers.
5. As you have been prescribed propranolol previously, I would also like to mention that propranolol )beta blockers type of drugs) can worsen asthma at times, so make sure your doctor treating migraine is aware that you have asthma.
6. As mentioned previously, Allergy testing followed by immunotherapy (if indicated) will be helpful to you. Because immunotherapy is the only available treatment for allergy in medical science at present.
7. As mentioned previously, diet and life style changes (Yoga, Pranayama, Breathing exercises, stress reduction, etc) are very important to reduce medicine requirements.
8. In general, please avoid exposure to dusts, smokes and air pollution as much as possible. Of course, air pollution is a problem in XXXXXXX I usually suggest my patients personal protective devices like face mask, full helmet, etc to avoid exposure to harmful air particles.
9. Regular steam inhalation will help you in obstructive nose symptoms.
10. Obesity can also worsen asthma and reduce lung capacity. A weight loss as low as 5-10% of your current weight may be helpful to improve your asthma control. You may seek a professional guidance for diet and exercise plan for weight loss.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello Sir,
Apart from steam inhalation for my blocked nose can you suggest any other medication/nasal sprays, which can be used regularly for my sinusitis, since i regularly have blocked nose and usually forced to breath through my mouth. I find that i do have a blocked nose during an asthamatic attack.
Kind regards,
XXXX
Apart from steam inhalation for my blocked nose can you suggest any other medication/nasal sprays, which can be used regularly for my sinusitis, since i regularly have blocked nose and usually forced to breath through my mouth. I find that i do have a blocked nose during an asthamatic attack.
Kind regards,
XXXX
Brief Answer:
ENT evaluation, intranasal corticosteroids, maintain nose haelth
Detailed Answer:
Hello Mr XXXX
Thank you for your follow-up.
In my opinion, steam inhalation is a very good option for daily use, as it is practically harm less.
Combination of montelukast + fexofenadine will also work on allergic rhinitis symptoms, but not fully, especially on congestion/obstruction.
However, as you have used decongestant drops for long time, I would suggest you an ENT specialist consultation who may examine your nose from inside and may suggest you Limited CT PNS scan to look for conditions of sinuses. This will also help to identify any structural problems within nose such as polyps, nose septum deviation, etc etc.
If you do not have structural problems inside nose and above mentioned medications do not work, I would suggest you to use intranasal corticosteroids (such as mometasone furoate or fluticasone propionate) which will work on nose obstruction also (of course, only if obstruction is due to non-structural cause).
Once your nose congestion is completely relieved, I would suggest you to continue with montelukast and steam inhalation as they are with least possible side effects among other options.
I would emphasize here importance of nose-sinus health for asthma patients. Most of the asthma attacks start with worsening of nose symptoms (obstruction, sneezing, running, etc) because the airway is actually a continuous from nose to throat to lungs.
Second important thing is nose filters many of the dusts/substances and prevent them entering lung. Patients with nose obstruction are often mouth breathers and hence harmful substances/allergens directly go into lungs and worsen asthma.
Nose also warms the inhaled air. Mouth breathing allows cold air to enter inside which is again not good for airways.
In short, nose health is very important for better lungs.
Hope above information will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
ENT evaluation, intranasal corticosteroids, maintain nose haelth
Detailed Answer:
Hello Mr XXXX
Thank you for your follow-up.
In my opinion, steam inhalation is a very good option for daily use, as it is practically harm less.
Combination of montelukast + fexofenadine will also work on allergic rhinitis symptoms, but not fully, especially on congestion/obstruction.
However, as you have used decongestant drops for long time, I would suggest you an ENT specialist consultation who may examine your nose from inside and may suggest you Limited CT PNS scan to look for conditions of sinuses. This will also help to identify any structural problems within nose such as polyps, nose septum deviation, etc etc.
If you do not have structural problems inside nose and above mentioned medications do not work, I would suggest you to use intranasal corticosteroids (such as mometasone furoate or fluticasone propionate) which will work on nose obstruction also (of course, only if obstruction is due to non-structural cause).
Once your nose congestion is completely relieved, I would suggest you to continue with montelukast and steam inhalation as they are with least possible side effects among other options.
I would emphasize here importance of nose-sinus health for asthma patients. Most of the asthma attacks start with worsening of nose symptoms (obstruction, sneezing, running, etc) because the airway is actually a continuous from nose to throat to lungs.
Second important thing is nose filters many of the dusts/substances and prevent them entering lung. Patients with nose obstruction are often mouth breathers and hence harmful substances/allergens directly go into lungs and worsen asthma.
Nose also warms the inhaled air. Mouth breathing allows cold air to enter inside which is again not good for airways.
In short, nose health is very important for better lungs.
Hope above information will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
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. Ashwin Bhandari
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
