Expert: Marc Rubin, RPh Asthma Educator - 6/9/2011

Question
QUESTION: Since 1979, I had allergic brochitis bout for which I used to take Deriphylin Retards 300 twice( etofylline 231 mg, theophylline 69 mg.) In 1989 I started having BP and tachycardia for which I was given Atenolol 100 and subsequently Amlodepine 10 mg and losartan 100 and Indapamide SR 1.5 added.

From 1989 till 2011, I had isolated twice or thrice seasonal variant bronchitis. Since March 2011, I had a shortness of breath while changing side during sleep and  PFT rvealed MODERATE RESTRICTION MODERATE OBSTRUCTION.INSIGNIFICANT RECOVERY. X RAY revealed There is a prominence of fundal gas shadow with elevation of left dome of diaphrag. Linear opacities are seen in left lower zone above the dome of diaphragm which appears to be due to small area of linear atelectasis. Minimal pleural thickening seen in the left costophrenic angle. Rest normal

I have been advised to discontinue atenolol 100 and advised to take Nebivolol 10 mg alongwith other above medicines though I find that since March 2011 till date, depsite taking nebivolol, I do not find any difference . I have been suggested Doxophyline 200 mg twice which has been discontinued yesterday.My query is as follows :

IS NEBIVOLOLOL 10 MG ABSOLUTE MUST IN VIEW OF WHAT IS EXPLAINED SINCE APRT FROM COST FACTOR I DO NOT FIND ANY QUALITATIVE CHANGE IN MY PROBLEM Can I take atenolol 100 because it is much cheaper than nebivolol ?

ANSWER: Hello Harvsdan,
In the states, the theophylline family of medication (xanthines), is used very little due to side effects and drug interactions. The approach to bronchitis over here is antibiotic therapy, where appropriate, bronchodilators to open the airways, and steroids to reduce inflammation.

I need to ask you a few questions before I go further:

1) your age and gender
2) have you in the past, or still presently a smoker?
3) Are there smokers in the household?
4) As a child, were you diagnosed with asthma?
5) Aside from the BP & tachycardia, do you have any other medical conditions for which you are being treated?
6) Are the medications you listed the only meds yo are on at present?

Once I hear back from you, I'll be in a better position to present you with some guidance. Most likely, I'll be able to respond on Sunday, since I'll be out for the next couple of days.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Respected Sir,

Many thanx for the prompt answer Details desired by your goodself are as follows :
1) I am a male/53 years
2) I am a non smoker/teatotaller/non tobacco chewer
3) Nobody smokes in the family
4) As a child, I was not diagnosed with asthma
5) Aside from the BP & tachycardia,I do not have any other medical conditions I am otherwise healthy individual
6) These are the only medicines listed being taken by me
I have never been on inhaler/sreoids or any other medications except the above mentioned for bronchitis

Answer
Hello Harvsdan,

I would discuss with the doctor a different medical approach. I'd initially start with a combination of (depending upon what is available) an inhalation steroid with a long-acting bronchodilator (they come in a single unit with both drugs). Typically, this would be fluticasone + salmeterol. In the dry powder inhaler, the dose would be 250/50, with a single inhalation every 12 hours. If, after 7-14 days you are showing improvement, I'd then stop the theophylline combination, with close monitoring of your heart rate and blood pressure. If you do not fall backward in symptoms, you may no longer need to take the BP/heart medication. From there, you would be re-evaluated every 2-3 months. The inhalation steroid actually take up to 6 months for full effect. You may also need a short-acting bronchodilator as needed for additional relief if you have a sudden worsening.

Also, what kind of occupation are you in? Any chemical exposures?

Let me know what the doctor thinks.

Sincerely,

Marc