Tuesday, February 19, 2013


     I often see patients with bronchial asthma . The good part about treating asthma is that if medicines are taken on regular basis , the patients can live normal life as it is fully reversible . In past I used to tell patients that the asthma is like Hershey's commercial , Now you have it , Now you don't . When the patient has attack of asthma , there is obstruction  to the air flow and patient feels short of breath , but when it is treated , then there is no obstruction and there is no shortness of breath.The story that I am going to tell is one where patient felt both on their own .
      I saw this young female with some cough . She ha two young children and was very active . She was not very short of breath , but was having bad cough . On examination her lungs sounded clear , though diminished air entry was noted . I did the work up with allergy blood test and pulmonary function test . She did have several allergies.Her pulmonary function test showed that she had significant airflow obstruction . Her lung capacity was reduced to 60 %out of 100, but her airflow was only 29 %. I am not sure why she was not short of breath . The only possibility was that she was not exerting hard enough . In any case she had sever asthma .
      I started her on the treatment . Her cough was gone and she was feeling better .I did new breathing test and her lung capacity had gone up to 80% and the airflow was up to 65 %. This was significantly better that the first one , though it was not normal yet . I had started  her on a combination of two drugs , one a long acting bronchodialator , and the other one steroid . The first one opens up the narrowed bronchial tubes , while the other one reduces the inflammation . For whatever reason many patients  don't like the name of steroids.I try to explain to patients that the amount of steroid in the inhaler is very small and the amount that is absorbed is minimal . So there are no systemic side effects of the inhaled steroids . But still some people are reluctant to use it . I was not aware of the fact that this patient had stopped the medicine .I came to know about this latter on .
     She went to a Chinese doctor (?) and he gave her treatment with acupressure . She then stopped the medicines . She had to go out of country for some meeting . While she was there , she started with shortness of breath . She was so bad that she ended up in emergency room . She was treated with medicines , nebuliser treatment and also was given Intravenous STEROIDS . She was better and when she came back , she was on her medicines that I had started , She came for the follow up and told me the story .
     I told her that asthma is like Good marriage , there is no 'divorce ' or separation . So one has to take medicines all the times , in most cases .

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