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Chronic Bronchial Asthma.

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Hello
I am a 31 year old single female suffering from asthma since childhood. I had a severe attack 1 week ago following bronchitis which was associated with high grade fever. I was in the ER twice for 5 hours each time due to cough and wheezing. Last time I was prescribed oral prednisone 40mg BD for 5 days. I finished the 3rd day today but am still coughing severely and wheezing . I throw up after repeated coughing so I cant hold any food or neds in my stomach. Am on nebulized ventolin and seretide diskus


Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

dear patient,
regards from doctor spring.
i guess you are having a bad time now with asthma exacerbation.
questions i would like to ask - what precipitated the exacerbation. 2) are you now protected from the iniciting agent? 3) is your medicines adequate( dose of seretide not mentioned)? 4) is your technique proper? what else needs to be done.
if you have vomiting, i will suggest an ER visit once more, so that they may correct your dehydration, give you an anti emetic and also one shot of hydrocortisone intravenous.
hope this attack was not precipitated by a change in job / lifestyle, nor exposure to dust. from what you have mentioned, i feel to think it was secondary to a viral infection which is usually self limited.
are you sure that the ventorlin and seretide discus you are using now still contains medicines and has not expired? when was the canister replaced last time? are you using ventorlin with a spacer? if not i would suggest a spacer.

if i was to treat you, i would stop ventorlin, start with symbicort 200/6 inhaler i puff four times a day, gargling after each use, stepping down to three times a day, 24 hr after symptoms are controlled, then a reduction to twice a day, again 24 hours after symptom control, and to continue so for 3 more days before continuing seretide discus. the same medicine( Symbicort) can be used as an SOS medication for exacerbations if any.
i would ask for a routine blood examination, and chest x ray to rule out a pneumonia thats causing so much of intractable coughing.
i would definitely advise to continue prednisolone 40 mg for 3 -5 more days in morning, after food, and along with that a monteleukast tablet 10 mg in night. for vomiting, a proton pump inhibitor and domperidone 20 mg before food should help. if coughing still persists, then i might add on doxophylline 400 mg twice a day for again 5 days.
i presume you dont have any nasal symptoms/ eye symptoms which are unchecked.
also presume you are not on any other medicines like pain killers or paracetamol.
i hope this should help.
wishing you a speedy recovery,
JACOB GEORGE P
MD, FCCP



Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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