Can biologics help with severe asthma for my mom?
Patient's Query
Hello doctor,
My 62-year-old mom has both severe asthma and COPD from smoking for 30 years, and she is getting worse despite quitting five years ago. She uses an Albuterol inhaler 8 to 10 times daily and still gets short of breath just walking from the bedroom to the bathroom.
Her pulmonologist has her on Advair, Spiriva, and Prednisone 20 mg daily, but the steroids are causing weight gain and high blood sugar. Her last pulmonary function test showed FEV1 of only 42 percent predicted. She has been hospitalized five times in the past year for asthma exacerbations, and the last time she needed a BiPAP machine to breathe.
The severe asthma also triggered a heart problem, and her ejection fraction is down to 35 percent now. She uses oxygen at night, but her oxygen saturation still drops to 84 to 86 percent. Tried Symbicort instead of Advair, but did not make any difference. Her peak flow readings are never above 200, even on good days. I am worried because she lives alone, and what if she has another attack and can not call for help? Are there any biologic medications that might help with severe asthma? Also concerned about long-term Prednisone use and what it is doing to her bones.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
Regarding your mom, who is 62 years old and suffers from asthma and COPD (chronic obstructive pulmonary disease), she smoked for 30 years but quit five years ago. In response to your query, the inhaler she is using, Albuterol, has a short half-life compared to newer inhalers.
Because of the frequent use of Albuterol, we recommend switching to a combination inhaler of Formoterol and Glycopyrronium, which has a longer half-life and will help manage both asthma and COPD. You can consider the use of Indacaterol along with Glycopyrrolate after consultation with your physician.
Additionally, she has cardiac issues, with her heart’s pumping capacity reduced to 35 percent. We advise careful titration of her heart medications, including antiplatelet drugs, diuretics, and possibly calcium channel blockers, in consultation with her local physician.
Lastly, given her reduced peak expiratory flow rate and nighttime oxygen drops despite oxygen therapy, we recommend using BiPAP (bilevel positive airway pressure) with oxygen support to maintain her oxygen saturation and ease her breathing.
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The probable causes: Smoking and age.
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Investigations to be done: 2D (dimensional)-echocardiography.
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Differential diagnosis: Lung issues added with cardiac.
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Probable diagnosis: COPD with asthma a/w cardiac LV (left ventricular) dysfunction.
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Regarding follow-up: Follow up after one week.
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Preventive measures: As described above.
I hope this information will help you.
Kindly follow up if you have any further concerns.
Thank you.
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