Saturday, February 6, 2016


    I have seen this in life and in medicine , that one does wrong thing , but gets right result. We sometimes call it side benefits . But this does not happen too often , thank God. So recently I had a case in which this was obvious .
   I had seen this 70 years old patient foe chronic cough and some shortness of the breath. He had history of heart problem and was treated by a cardiologist and his heart was OK . So he came to me . He was not in distress and his lungs sounded clear and so I did the tests like Breathing test , oxygen check on walking and some allergy work test . I also did pulmonary stress test. All the tests came back OK except breathing test which showed mild asthma. I started him on an inhaler and gave him steroids . He got better and came for follow up once and then did not come back . I got a call from his PCP telling me that he had several bouts of cough . He had stopped the inhaler as he felt that it did not help. Interestingly enough the steroids helped and in the 5 months that he did not see me , he had taken 3 or 4 courses of steroids . Each time it worked , but as soon as steroids were stopped , the cough came back. So the PCP called me . I told her to do high resolution CT scan and the decided to do bronchoscopy. I also told her to do longer duration of steroids at smaller dose.
I was not too sure if bronchoscopy would add anything to the diagnostic scope. But I have done few bronchoscopy in past for persistent cough and did not get any different information that I did not have before the bronchoscopy.
   The CT scan came back OK . There were no damaged bronchi or what is called bronchiectasis . There was no scar tissue . So I did the bronchoscopy . The bronchoscopy showed significant inflammation. Which can explain cough and why he responded to treatment with steroids.  So I was not sure as to why the treatment for asthma did not work . Anyway I also ordered blood tests to check on Immuneglobulin. There are 5 of them and each one has a specific function. I have seen few cases in which reduction in some of them patient had persistent cough and inflammation. This was along shot. But to my surprise his all immune globulins came back very low . This condition is called CVID .It will need further work up and treatment with immunoglobulin  every month or more often.  

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