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What Causes Difficulty In Breathing When Diagnosed With Usual Interstitial Pneumonia?

Posted on Mon, 28 Aug 2017

Question: Sir, My mother (55 y, Diabetic, Thyroid issue, allergy issues) has started to have extreme difficulty in breathing and has been diagnosed with UIP-ILD. Is there any way to prevent her condition from worsening? Is a recovery possible? Please suggest and help sir. She is currently being provided oxygen externally and a whole lot of medicines are being given. She feels better but I am concerned.

Answered by Dr. Drkaushal85 (19 minutes later)

Brief Answer:
It is chronic progressive disease.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
Sorry to say but UIP - ILD (IPF - idiopathic Pulmonary Fibrosis) is chronic, progressive lung disease.
It is not curable.
We can only slow down the progression of disease.
So 100% recovery is not possible.
Newer drugs like Perfinodone (perfinex), N acetyl cystine (Mucinac) should be started.
We should also see for pulmonary hypertension and if it is there then tadalafil (Pulmo press) should be started.
Long term oxygen therapy (LTOT) is also beneficial for symptomatic relief.
Please let me know if she is taking all these medications or not.
I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (14 minutes later)

The problem started to surface around 23-24 July 2017. On 25th, a few tests like ECG, echocardiography and TMT were conducted. The doctor inferred Reversible Myocardial Ischemia. But when the condition was not getting better, we consulted a cardiologist in XXXXXXX After HRCT Thorax (Chest) scan, the doctor concluded ILD. Then he initiated the procedure of discharge of the patient from the hospital. Now we have consulted a chest specialist (perhaps a XXXXXXX pulmonologist) in XXXXXXX and he has been supervising my mother's condition. If you need CT scan reports...I can provide.Here are all the reports apart from the ones provided on the profile page.The medicines you have mentioned are perhaps not being given. I have provided the list of medicines being given alongside the original question.

Answered by Dr. Drkaushal85 (48 minutes later)

Brief Answer:
Is she intubated and on ventilatory support?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I have gone through the drug list you have written.
Please let me know
1. Is she intubated and on ventilatory support?
2. Is she in hospital or at home?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (15 minutes later)

She is not on a ventilator currently. Externally oxygen is being supplied using an oxygen cylinder and a mask...kind of set-up.
She is in a hospital.
http://www.rkchpatna.com/

Sir, please don't mention anything about this case if you happen to contact the chief doctor there. I guess, doctors don't usually like interference in their methods. I hope you understand my concerns. I am curious to know what can be done, and what should be done. Also, the two newer drugs you mentioned earlier... should we mention it to him?

Answered by Dr. Drkaushal85 (15 minutes later)

Brief Answer:
I know professional secrecy.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Don't worry, I won't discuss this allergy with any one. I know professional secrecy.
And yes, you should definitely discuss with doctors about starting Perfinex and Mucinac.
Some doctors don't start these drugs in acute conditions. So they might start once she is little bit stable.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (18 hours later)

Sir, what are the risks of having angiography done in the case of my mother.
I mean is it safe?
Earlier, while ILD had not been diagnosed, doctors were reluctant to proceed for angiography as her condition was not very good.
I have been suggested by another doctor that to be sure that there is no cardiac issue we should have angiography done.
I am unsure if it is safe enough at this stage. If you can suggest the line of action, it would be helpful.

Answered by Dr. Drkaushal85 (32 minutes later)

Brief Answer:
Angiography is risky investment her case.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Conventional angiography is risky in her case.
Conventional angiography is invasive procedure.
It is better to go for CT coronary angiography. It is non invasive and hence safe for patient.
Please let me know
1. Is your doctor talking about conventional angiography or CT coronary angiography?
2. Is he thinking about pulmonary angiography or coronary angiography?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Drkaushal85 (22 minutes later)

The doctor treating her has not said anything as such. He is conducting the necessary tests, taking observations and thereby proceeding as required.

The doctor I spoke of in my earlier query is a different one. He knows about the case too. He just suggested the coronary angiography, if possible, but nothing specific about CT angio or conventional angio. He advised to do so in case the angiography ( either invasive or non-invasive) could be safely performed. I asked for your opinion. Any further suggestions are welcome.

Thanks

Answered by Dr. Drkaushal85 (11 minutes later)

Brief Answer:
Treating doctor is a better guide about angiography.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Sorry to say but it is very difficult to advise about angiography without seeing patient in person.
Angiography is very important investigation.
So treating doctor is the best person to decide whether patient needs angiography or not and also type of angiography.
In my opinion, you should discuss about this (need of angiography and type of angiography) with treating doctor and go further accordingly.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Drkaushal85 (21 hours later)

Hello Sir!

She was recovering quite well, but yesterday in the evening her pulse started fluctuating a bit and the condition deteriorated a little. The doctor had to put on a semi-ventilator or mini-ventilator kind of arrangement to help compensate for the breathlessness.
I want to know is it advisable to use an air ambulance service to shift her to apex hospital in XXXXXXX or XXXXXXX or any other place.

Answered by Dr. Drkaushal85 (6 minutes later)

Brief Answer:
I want more information to answer this.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Shifting of critically ill patients is very difficult and should be done if proper setting is there.
So I want to know few more things to do answer this question.
Please let me know
1. What do you mean by XXXXXXX ventilator?
2. Is she conscious? Is she talking to you?
3. Is she on any inotropic drugs (drugs used to increase blood pressure)?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (1 hour later)

XXXXXXX ventilator is what the attendants present there called that device. On its packaging it was printed nebulization mask.

Not sure if blood pressure regulating medicines have been given.
She is talking. She is conscious.
Before 3 pm yesterday she was doing pretty well, almost as in normalcy except that external oxygen being supplied via oxygen mask. She was having food too.

Last night when I visited her in the ICU, her pulse reading on the monitor was stable with values around 90 to 94.

Given her condition, she may have been given bp regulating drugs, but I don't know for sure. Tell me what to do in either case. Please. Currently, the doctor won't be available for 48 hours, and he has approved that she may be transferred to XXXXXXX (AIIMS, likely) with safety. Therefore, please let me know what are the possible options.

Answered by Dr. Drkaushal85 (2 minutes later)

Brief Answer:
Nebulization machine is simple thing, it is not ventilator.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Nebulization machine is simple thing. It is not ventilator.
By your description, it seems she is in stable state.
Her doctor also allowed for shifting. This also suggests that she is stable now.
But there is always a risk in shifting patients.
So you are XXXXXXX to keep that risk in back of your mind.
One more thing. Why do you want to shift her? I mean what makes you to think about shifting?
By your description, she seems to be improving and doing good with current treatment.
It's absolutely fine if you don't want to answer this.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng