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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for bronchital asthma

hello doctor . i m from bangladesh....my father has been suffering from chronic bronchial asthma for 4 years......he used prednisolone, ipraatopium, seretid accuhaler inhaler, salmeterol inhaler, euphyllin.he is 48 years old not diabetic, but hypertensive for 5 years.though using all drugs he is also attackted by asthma everyday.then it is necessary to give 100% o2. now i want to consult you .......if u kindly advice me ....i will grateful to you...

with regads- Masum Habib (student of MBBS course)
Mon, 2 Mar 2015
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Allergist and Immunologist 's  Response
Hello Masum Habib,


Thank you for asking at HCM.

I went through your father's history and would like to make suggestions for him as follows:

1. I would like to know in great detail what are his symptoms of asthma, how it was diagnosed, whether he is allergic, what are his nose/sinus symptoms, whether he is/was a smoker, his environment, etc etc.

2. I would like to mention here that it is possible that he may need O2 for a severe attack. But it is unusual of asthma to require O2 too often. That's why I would suggest him spirometry with post-bronchodilator reversibility testing which measures his lung capacity, airway reversibility and response to bronchodilators. Spirometry will also help to identify whether he really has asthma, or COPD or so called asthma with irreversible obstruction or similar disorders. Spirometry will also help to choose appropriate medications and inhalers for him.

3. For him, I would also suggest Chest X-ray as it is unusual for a normal asthmatic patient to require O2 too often.

4. I would like to know about his antihypertensives. Beta-blocker group of antihypertensives can aggravate asthma or bronchoconstriction. So if he is taking beta-blocker group of drugs, I would suggest to consult his physician to look for possibility of other group of drugs.

5. Regarding treatment, I would suggest him regular combined inhaled corticosteroids + salmeterol or formoterol. As he is already taking Seretid and not controlled, I would suggest him to increase dosing.

6. If he is allergic, I would add montelukast in his regular treatment. If he has allergic rhinitis also, I would add montelukast + levocetirizine in his regular treatment.

7. Please continue all drugs as prescribed by his physician. Asthma needs regular treatment. Fr in-between attacks, I would suggest him to use salbutamol or combined salbutamol-ipratropium inhaler.

8. I usually prescribe ipratropium for severe asthma attacks. For regular preventer treatment, tiotropium is preferred over ipratropium.

9. If he is allergic, I would suggest him allergy testing for common inhaled allergens such as house dust mites, molds, pollens, insect proteins, pet dander, etc. This will help you to know identify the substances he may be allergic to and also to know the measures to avoid them. However, looking at severity of asthma, allergy testing would not be my first priority.

10. In general, please avoid exposure to dusts, smokes and air pollution as much as possible.

11. Regular breathing exercises including Yoga & Pranayama and a healthy diet rich in vitamins, minerals & antioxidants will also help him in a long run by improving his lung capacity and immunity respectively.

Hope above suggestions will be helpful to him.

Should you have any further query, please feel free to ask at HCM.

Wish your father the best of the health ahead.

Thank you & Regards.
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Suggest treatment for bronchital asthma

Hello Masum Habib, Thank you for asking at HCM. I went through your father s history and would like to make suggestions for him as follows: 1. I would like to know in great detail what are his symptoms of asthma, how it was diagnosed, whether he is allergic, what are his nose/sinus symptoms, whether he is/was a smoker, his environment, etc etc. 2. I would like to mention here that it is possible that he may need O2 for a severe attack. But it is unusual of asthma to require O2 too often. That s why I would suggest him spirometry with post-bronchodilator reversibility testing which measures his lung capacity, airway reversibility and response to bronchodilators. Spirometry will also help to identify whether he really has asthma, or COPD or so called asthma with irreversible obstruction or similar disorders. Spirometry will also help to choose appropriate medications and inhalers for him. 3. For him, I would also suggest Chest X-ray as it is unusual for a normal asthmatic patient to require O2 too often. 4. I would like to know about his antihypertensives. Beta-blocker group of antihypertensives can aggravate asthma or bronchoconstriction. So if he is taking beta-blocker group of drugs, I would suggest to consult his physician to look for possibility of other group of drugs. 5. Regarding treatment, I would suggest him regular combined inhaled corticosteroids + salmeterol or formoterol. As he is already taking Seretid and not controlled, I would suggest him to increase dosing. 6. If he is allergic, I would add montelukast in his regular treatment. If he has allergic rhinitis also, I would add montelukast + levocetirizine in his regular treatment. 7. Please continue all drugs as prescribed by his physician. Asthma needs regular treatment. Fr in-between attacks, I would suggest him to use salbutamol or combined salbutamol-ipratropium inhaler. 8. I usually prescribe ipratropium for severe asthma attacks. For regular preventer treatment, tiotropium is preferred over ipratropium. 9. If he is allergic, I would suggest him allergy testing for common inhaled allergens such as house dust mites, molds, pollens, insect proteins, pet dander, etc. This will help you to know identify the substances he may be allergic to and also to know the measures to avoid them. However, looking at severity of asthma, allergy testing would not be my first priority. 10. In general, please avoid exposure to dusts, smokes and air pollution as much as possible. 11. Regular breathing exercises including Yoga & Pranayama and a healthy diet rich in vitamins, minerals & antioxidants will also help him in a long run by improving his lung capacity and immunity respectively. Hope above suggestions will be helpful to him. Should you have any further query, please feel free to ask at HCM. Wish your father the best of the health ahead. Thank you & Regards.