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Fyrther course of treatment for COPD with OMNACORTIL.

Resolved Question:

My mother aged 65 suffering from copd grade 3. She is now taking omnacortil, ab flo sr 200 & odimont lc. COPD diagnosed two years old patientbefore. Latest report dated 22.07.2015 as FVC - 58%, FEV1 - 53%, FEV/ FVC - 73%. she is presently facing tighten abdomen with absolutely no hunger feeling. She had not taken any food for last 4 days and feeling complete weakness. Pl advise any further course of treatment.


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.

Thanks for your query at DoctorSpring.com
Regards from our team.
I would like to know the total duration of symptoms of your mother, (total Dustin of breathlessness)
whether she has ever been on inhalers,
duration of current symptoms, (total duration of current illness)
any fever or weight loss,
Sleep, bowel habits.
Whether she smokes, smoked or exposed to serving hand smoke / household smoke
Current status of breathlessness?
duration of taking omnacortil?
associated itching of nose, throat, eyes, sneezing,
snoring?
Associated heartburn, dyspepsia symptoms
Any difficulty in swallowing
Other medicines - if any
Any calcium vitamins, hormone supplementation.
Any chest x-ray taken?
Any other symptoms such as cough?
Was the spirometry repeated after nebulized drugs?
Please answer so that I may be able to help you better.
Regards
Dr. Jacob George P
MD IDCCM FCCP


Patient replied :

1. Total duration of symptom of my mother - 2 year. (COPD dignosed 2 year before) 2. She has been using seroflow 250 for last 5 years. 3. Duration of current sympton - 10 days. 4. No Fever, Weight gain, late night sleep, constipation. 5. She left smoking 6 months before. 6. Afetr using inhaler, breething problem is reducing. 7. She used omnacortil for last 7 days. Two days before i stopped it. 8. Presently no itching. 9. hse is having swolling problem. She doesnt like to swollow any thing. 10. She is taking ab flo sr 200, odimont lc & gemcal aprt from inhaler. 11. No vitamines or food suppliment 12 presently no cough. But sometimes it is there. 13. X RAY taken 2 months before. 14. spirometry is not conducted after nebulised drugs.


Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Going through the history provided, I think she is having copd on top of asthma. Her present symptoms are probably due to asthma exacerbation. So given steroids, which caused reduced appetite and fatigue.
Suggest calcium supplementation regularly, vitamin d3 supplementation for a month, and mild exercises. I would have opted for repeating Spirometry after nebulization. Presuming chest xray is normal, suggest adding on tiotropium inhaler twice a day with seroflo. Stop abflo and omnacortil, and consider using medicine like neopride total one capsule daily for at least a week.
Ask for vaccination recommended for this age.
Hope that helps.
Regards


Patient replied :

Thanks for prescribing suitable medicine....she is telling dulin through nubulisation works better. Can i continue the same or as advised by u above. Pl advise name of calcium supplement keeping in mind that she is taking gemcal everyday. Pl also suggest vitamin d3 supplement name for better suit. I have stopped abflo n omnacortil as advised. I will continue neopride total for a week. But, after a week is there any new medicine?. Pl advise. Final prescription as below- 1. Neopride total-1@night after dinner. 2. Odimont lc 1 night. 3. Dulin through nebulization three times a day. 4. Gemcal/calcium supplement/vitamine d3 supplement. One important thing, pan 40 is also required. Can she take curd with salt for better appetite...if i will stop ab Flo which was medicine for copd n asthma. Is there any substitute for this? Since neopride and odimont lc are not for main copd problem. Pl also advise vaccination name as u advised...thank u very much sir.


Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Suggest calcium supplementation regularly - gemcal will do.
vitamin d3 supplementation for a month- calcirol 60000 one sachet / week for 6 weeks
and mild exercises.
tiotropium inhaler 1 puff twice a day
Continue with seroflo.
If nebulization is being done, try duolin and budecort three times a day- which will be costly on long run. So other inhaler with a spacer as advised.
Stop abflo and omnacortil,
and consider using medicine like neopride total one capsule daily for at least a week before food in morning.
Ask for vaccination -Pneumovac and influgen.
Final prescription as below- 1. Neopride total-1@ morning before food.
2. Odimont lc 1 night.
3. Duolin with budecort nebulization three times a day. ( prefer inhaler with soever better)
4. Gemcal/calcium supplement/
vitamine d3 supplement one a week.
One important thing, pan 40 is also required - not when she is taking neopride total.
Can she take curd with salt for better appetite. Yes, she can.
If i will stop ab Flo which was medicine for copd n asthma. Is there any substitute for this?- both inhalers should do. One Puff twice a day with spacer, gargle after use
These are just suggestions. Please consult your primary physician who had seen and understood your mother better.
Regards,

Dr. Jacob George P
MD IDCCM 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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