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Thursday, June 17, 2010

A Family Doctor's Tale - ASTHMA & BREATHLESSNESS


Ever get woken up by your child or old parents gasping for breath and wheezing away. Many cases of asthma have their attacks of asthma worse at night. Some may even call you for a house call.

Asthma was another medical condition that affects the life of many patients.

Bronchial asthma  has its origin in hereditary allergy - skin ( A Simple Guide to Eczema), nose (A Simple Guide to Vasomotor Rhinitis) and lungs ( A Simple Guide to Asthma) .

Avoidance of dust, dirt, and changes of temperature was very important in helping the patient regain a normal life.
Stress (A Simple Guide to Stress)and smoking are the other triggering factors.
In fact some doctors especially pediatricians (children doctor) classified prolonged cough above 2 weeks as asthma and often give bronchodilators to open the narrowed air tubes.

My treatment for asthma after doing a X-ray of the chest to exclude other conditions such as tuberculosis was typically to give an intravenous injection of aminophylline which work very well and fast for acute asthmatic attack. Intravenous injection delivers the drug within 2 minutes and the asthma subsides rapidly.  
I became well known for my intravenous injection and its rapid relief. 
Intravenous injection was something I learned to give even with small veins during my anesthetic days.

Besides the injection a bronchodilator such as diprophylline  and a steroid such as dexamethasone( I do not like prednisolone)
was given on a tapering dosage.
An antihistamine may be given at the same time to prevent allergies. 

It is also important to stress to the patient to live in a dust free environment and avoid sudden changes of temperature. 
At the same time the patient was advised to learn to relax and do deep breathing exercises. 
One of the best exercises for asthmatics was swimming which help the patient to learn to breathe properly. 
It was one of the reason why many champion swimmers had an asthmatic history. Some of them are even allowed to use a ventolin inhaler before their swim.

The ventolin inhaler is prescribed for acute attacks. 
Sometimes a steroid inhaler is used to prevent the attacks of asthma.
The correct use of the inhaler must be taught in order to get maximum effect from the medicine in the inhaler.

In some young children a respiratory nebuliser may be used to provide air, steroid and bronchodilator into the lungs during an emergency asthmatic attack.

Because I was able to treat quite a number of asthmatic patients successfully , many patients were referred to me for breathlessness and chronic cough ( A Simple Guide to Coughing). 

It was important that every patient should have a X-ray of the Chest done to exclude other serious illness such as tuberculosis or cancer of the lungs.

In elderly patients above 50 years old there is such a condition known as cardiac asthma which is basically a mild form of heart failure due to their age. 
One of the ways to find out is to ask whether there is breathlessness on climbing 3 flights of stairs or walking long distance. 
The other way is to check for the presence of ankle edema and basal creps in the lungs.
Because of the heart failure congestion of blood builds up in the lungs and reduce the capacity of the lungs to breathe.

It is my normal routine to check for ankle edema in all elderly patients. 
A small dose of diuretic (to help pass water out) helps to reduce the congestion in the lungs and relieve the breathlessness  of the patient and his/her chronic cough.

With these simple treatments I was able to control asthma, breathlessness and chronic cough.

Many patients come to see me when their chronic cough cannot be cured by other doctors.

One notable case was a patient who was given enapril by her doctor for hypertension(A Simple Guide to Hypertension). Enapril and other ace-inhibitors for hypertension has a reputation for causing cough in patients. 
From her history I found out that her cough started after the change of medicine to enapril by another doctor. 
So I stopped her enapril and put her on another hypertension medication.
After the change her cough disappear totally and she was happy enough to recommend any friend with chronic cough to see me.

Health education and a proper history is very important in the treatment of any disease including asthma. 
A doctor must always be ready to listen in order to treat properly.

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