Dr. Rahul Reddy Keesari
Pulmonology (Asthma Doctors)
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,
A patient is having a breathing problem. I want to know whether it is a curable or autoimmune disease. She previously had a migraine headache. I am sending her reports. For one year, she is having this problem. Kindly give your opinion.
Hi,
Welcome to icliniq.com. I have gone through the reports (attachments removed to protect the patient's identity). It looks like ILD (interstitial lung disease). It is an irreversible condition. I suggest starting on tablet Wysolone (Prednisolone) 10 mg twice daily for two weeks, followed by 10 mg morning for two weeks, followed by 5 mg twice daily for two weeks. After finishing steroids, I suggest tablet Pirfenidone 200 mg twice daily for two months or tablet Nintedanib 150 mg twice daily for two months to be used. If oxygen is below 90, go for oxygen support. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. The patient has completed her five days course of Wysolone 10 mg (taken it twice daily), as per the advice. Till yesterday her position was good, and even oxygen saturation (SpO2) was 95 with a pulse of 107. But since today morning, she is continuously coughing and complaining of a burning sensation in the food pipe. Today her SpO2 is 93 with a pulse of 127. She is restless due o continuous coughing. What shall be provided to her, and what special we have to do for burning sensation in the food pipe? Is this caused by the steroids that she is taking? What is the remedy for continuous coughing? Previously she was advised to take Wysolone 10 mg twice daily for two weeks then Wysolone 10 mg once daily for two weeks, but after that, it was mentioned Wysolone 5 mg twice daily for two weeks. So it becomes 10 mg in a day. It is right, or you wanted to give 5 mg once a day for two weeks. Please clarify the doubt.
Hi,
Welcome back to icliniq.com. 5 mg twice daily for one week followed by 5 mg once daily for one week has to be given. For the burning sensation in the food pipe, I suggest adding tablet Famotidine 40 mg daily once in the morning before breakfast (could be due to steroids). But not a serious issue, it will improve. After the steroid dosage, go for Pirfenidone or Nindetanib for two months. As said, interstitial lung disease (ILD) is an irreversible condition, and whatever treatment we give is to relieve her symptoms and not treat her condition. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. Can she take the COVID vaccine? As she has not taken any vaccine till time. If she can take then which vaccine is preferable to her, Covaxine or Covishield? As per her interstitial lung disease (ILD), are these vaccines safe? Can she take Corex DX or Zedex cough syrup 5 ml twice a day, or should the dosage be changed? Kindly give your opinion.
Hi,
Welcome back to icliniq.com She can take any vaccine (no specifications). It is safe in interstitial lung disease (ILD). Any syrup containing Dextromethorphan can be given. I hope this was helpful.
Patient's Query
Thank you doctor,
She has started taking doses of Wysolone 10 mg twice a day to once a day from yesterday. Today, she has a fever of 100 degrees and she is coughing continuously. Even though she takes cough syrup, she seems very much restless. What is the next protocol? Does using a nebulizer help? If yes, what can be given?
Hi,
Welcome back to icliniq.com. She can take tablet Pcm 650 (Paracetamol) every six hours. Duolin and Budecort 500 mcg nebulisation can be used. It can be used at a gap of 15 minutes twice daily for three days. It is good to give tablet Nindetanib 150 mg twice daily for two months. If her SpO2 goes below 90 with complaints of breathlessness, kindly admit her.
Patient's Query
Thank you doctor,
Can she take Nindetanib 150 mg twice a day along with Wysolene step-down course? Her SpO2 remains around 94 and pulse of 89 beats per minute. Can we increase the dose of cough syrup?
Hi,
Welcome back to icliniq.com. She can take Nindetanib with Wysolone step-down course. Her Spo2 and pulse are fine. She can continue taking cough syrup.
Patient's Query
Thank you doctor,
Now, the lady is taking medicines as per your advice. She takes Wysolone 10 mg once a day, cough syrup Corex DX one teaspoon twice a day, Budecort 500 mcg, and Duolin 500 mcg nebulizer. She has a SpO2 of 94 percent and a pulse of 100 beats per minute. She is having continuous coughing at night. She is unable to sleep. During the daytime, she has lots of coughing. She does not have any relief even after taking a Nebulizer for three days. She felt better when she took Wysolene 10 mg twice a day. Kindly advise. What is the next protocol? How to provide relief for coughing?
Hi,
Welcome back to icliniq.com. Previously, I have advised her to take Wysolone with Nindetanib 150 twice daily for two months. Please mention whether she takes it. If not, she can take Wysolone with Pirfenidone 200 two tablets twice daily for two months.
Patient's Query
Thank you doctor,
Please note the patient has the following symptoms now. She still has a coughing problem. She is able to sleep only on the left side and she is unable to sleep on the right side or straight position. For the last six to seven days, she has stopped taking cough syrup by herself. I have asked her to start it again. Her Spo2 remains around 96 while coughing and pulse rate around 110 beats/minute. When she remains calm, her Spo2 remains around 94 and pulse around 104 beats/minute. At present, she takes Pirfenidone 200 mg twice daily, Wysolone 5 mg once daily, Syrup Corex DX 5 ml twice daily. What can be done to improve her coughing problem? As she is going to complete taking Wysolone 5 mg twice daily, what should be her next dose and when it should be stopped? As she is not able to sleep in other positions, so she can have problems with the left portion of the body. Please advise.
Hi,
Welcome back to icliniq.com. She can take nebulization with Duolin and Budecort 500 mcg respules twice daily for two days. For a dry cough, she can take Reswas syrup (Chlorpheniramine Maleate with Levodropropizine). For a wet cough, she can take Grillinctus BM 10 ml (Bromhexine with Terbutaline) in the morning and night. Stop taking steroids completely. Pirfenidone should be sufficient as steroid use can be taken indiscriminately. She can take tablet Aceclofenac daily till her pain resolves as it cannot be rectified permanently.
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Pulmonology (Asthma Doctors)
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