How to treat breathing difficulty in a person with asthma and hypertension?

Hi,

Welcome to icliniq.com.

I understand your concern. I want to go through all the reports first. Please send me all the tests you have done and the chest X-ray. Also, please mention your age, your family history of cardiac diseases, and your habits, such as smoking, alcohol, etc. I have allowed free follow-up, so you do not need to pay again after sending the reports to me. I hope you find it helpful. Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your concern. I have reviewed all your reports (the attachments are removed to protect the patient's identity). Everything is under control except for minor issues you are already aware of. But I wish to bring to your notice some concerns. Your breathlessness is not due to any organic lesion. By that, I mean that it is not a sign of a cardiac problem or damage in the lung, or any pulmonary infection. It is probably due to bronchospasm caused by prolonged standing asthma or a bout of allergic reaction. The ideal way to evaluate is to auscultate the chest to look for any local rhonchi or crepts, which we cannot do online. I would suggest the following. Get yourself examined by a local doctor to rule out rhonchi in the chest. You can increase the usage of the Foracort (Formoteroland Budesonide) to three times a day till the spasm is settled. Avoid dust, smoke, etc., which can give rise to spasms. Also, since your ESR (erythrocyte sedimentation rate) is high, we can suspect an allergic reaction sometime back. You can check serum IgE (immunoglobulin E) levels to confirm allergic sensitivity, which might be causing your asthma also. Consult your doctor and consider using a Tiova inhaler (Tiotropium) rather than Foracort as long-term prevention. Foracort is used to settle acute cases and is not meant for prevention. Consider alternatives to Telma AM (Telmisartan and Amlodipine), the reason being the causes of the increase in heart rate and water retention in the body, which is evident in your echo (echocardiogram) report. It is an old drug, and better alternatives are available. I suggest taking Doxofyllin 400 mg daily to settle the breathlessness. Reduce protein intake as it is hampering your renal functions. You can also add tablet Febutaz 40 mg (Febuxostat) once a day to clear up all the uric acid, as it might lead to stone formation in the future. I would have been able to give you a better solution if I could examine you. However, this is the best that we can infer from the reports. I hope you find it helpful. Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your concern. Adding so much lemon makes the liquid acidic in pH (potential of hydrogen); thus, your urine will also become acidic. This results in the precipitation of uric acid crystals in the body, which is why uric acid is high. Therefore, avoid acidic fluids such as lemons, juices, etc. Losar is a good drug, but it might not be sufficient for you. As per the JNC (joint national committee) 8 guidelines, the treatment should always be started with a diuretic medicine, and then we can add other drugs. This was not done in your case. Discuss with your doctor and take the Thiazide group. One alternative is tablet Trilosar 6.25 (Losartan, Amlodipine, and Chlorthalidone) or tablet Losar- H (Losartan and Hydrochlorothiazide), or tablet Telma- H (Telmisartan and Hydrochlorothiazide) depending on your body type and BP (blood pressure) levels. Defocort (Deflazacort) is a potent steroid. Therefore, it should be used with caution. You can take the antibiotic Azee (Azithromycin), but we are not suspecting infection here. I suggest you try the tablet Montek-LC (Levocetirizine and Montelukast) for three days. Half a tablet morning and one at night. This is an excellent antihistamine and would cure your attack to a large extent. I hope you find it helpful. Kind regards.

Hi,

Welcome back to icliniq.com.

Yes. It goes in support of our diagnosis of allergic pharyngitis. Use tablet Montek- LC as suggested earlier and saline gargles at night with lukewarm water. Symptoms get settled in three to four days. Get an IgE level tested. One more thing which can cause this is your inhaler. When you use Foracort, it gets stuck to your throat and can cause this irritation. So you can use gargles after using the inhaler. Or you can shift from liquid to powder inhaler Rotacaps (Formoterol and Budesonide). I hope you find it helpful. Kind regards.