Dr. Amol Kumar Wasudeorao Diwan
Allergy Specialist
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am looking for a specialist opinion. My wife is diagnosed with pulmonary fibrosis. She has a small rim of pneumothoraces bilaterally with subcutaneous disease and mediastinal emphysema. I am attaching her reports. Kindly suggest a treatment to manage the condition.
Hi,
Welcome to icliniq.com.
I have gone through the CT scan reports and images (attachment removed to protect patient identity). It seems to be a long-standing problem and it progresses fast. You have not mentioned the chief complaints of the patient and previous treatment details. According to the CT (computed tomography) scan, it looks like NSIP (nonspecific interstitial pneumonia) and it is a chronic type of interstitial lung disease. It gets complicated when there is leakage of air in the lungs and heart. It is important to know the oxygenation status of the patient and other comorbidities.
This condition is treated by taking steroids as per the weight. If the oxygen saturation is not above 92 % on room air, then oxygen supplementation is given either by cylinder, concentrator, or NIV (non-invasive ventilation). So it is advisable to consult a pulmonologist to take medicines and other treatments under his observation. If the patient has any other autoimmune diseases, then it should be treated simultaneously.
The Probable causes
Differential diagnosis
Probable diagnosis
Treatment plan
Patient's Query
Thank you doctor,
My wife is 62 years old. Two and a half years ago, she got a breathing problem while walking. We consulted a pulmonologist. The doctor advised her to do some tests including HRCT and I have attached it. She was prescribed with tablet Deltacortril and tablet Cellcept. During her treatment, the doctor conducted some pulmonary function tests. After a few days, she got recovery and continued to have a normal life. After a year, she started to have breathing problems again.
After that, she did a pulmonary function test and it does not show any abnormal results. This situation got serious and we consulted another pulmonologist. After consulting him, we did an HRCT and he changed some medicines. After taking it, she was comfortable with her breathing and her average oxygen status was about 95% on room air without the support of an oxygen cylinder or concentrator. She does not have diabetes, allergy, or hypertension. She does not have smoking or drinking habits. Currently, she has a weight of 121.25 pounds and a height of five feet. I have attached the reports
Hi,
Welcome back to icliniq.com.
On going through the CT scan reports and previous reports, it is clear that she is suffering from chronic lung fibrosis. There is no cure for this disease but we can control the symptoms by taking medicines. She was taking tablet Cellcept (Mycophenolate mofetil) and tablet Amyron. Due to disease progression, the effects of medicine gone down and her symptoms got worse. In this condition, it is good to consult a pulmonologist and she can take tablet Pirfenex 150 mg (Pirfenidone). It helps a lot. It is necessary to monitor her liver function tests after taking tablet Pirfenex. Instead of tablet Deltacortil, it can be replaced with tablet Medrol 32 mg (Methylprednisolone) in tapering doses. She can continue taking other medicines along with it. Oxygen has to be supplemented according to the oxygen saturation.
The Probable causes
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Allergy Specialist
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