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Asthma/Dyspnea episolic


QUESTION: I am 59 years old with height of  5 ft  7inches & wt of 56 to 58 kgs.My wt was stable around 53 kgs for nearly 20 years.I used to be very active with only problem of Cold,cough,asthama ,allergy,ashthama usually on extertion or tension.My bloodpressure is very within normal range 120/80
Since last 3/4 years i found i am getting bit breathlessness on exertion since become nonactive and retirement.i am consulting Pulmonologist.He has prescribed Natrilix SR 1 in morning and Doxolin 400 mg half tablet twice in a day.I felt better but recently he started with Theophyllin 400 mg half tablet twice a day and Torsemide one in morning.I started feeling very uneasy and nervous.When i mad eco,plain to doctor he told me nothing wrong in medicines.I have of anxiety and nervous nature nowadays.But i still have doubts about Theophyllin and Torsemide.When my other symptoms are quite normal,heart conditions are good why he should give me Torsemide. and why Theophyllin instead of Doxolin.
I have started doubting doctor and because of his  ego he doesnot try to understand my side effects.

He prescribed medicines after Pulmonary Fuction test which was Severe Res Severe Obs ESA Obs Low VC.

Pl advise I should not become habituated of Torsemide which i am afraid affect my kidneys and heart in long run.And I came to know Doxofyllin is much better than Theophyllin as told my Dr brother who is in USA.

Thanks and regards

Sharad Sheth
Ahmedabad ( India)
Cell - 91-9825032309 / 9327949950

ANSWER: Hello Sharad,

  Sorry for the delay. Apparently the All Experts server dropped this one.

Are you now, or were you a smoker?

I'm not sure if you have provided me all of your medical history, since Natrilix SR & Torsemide, both diuretics (water pills), are use for elevated blood pressure, and also heart failure. Your pulmonary function results are an indicator of impaired lung function. If you never smoked, was the work you did for a living expose you to inhaled chemicals which may have had this effect on your lungs?

Torsemide is not a habit forming medication. Theophylline is more the standard in the class of drugs it belongs to (methylxanthines). Doxolin is not available in the US. Over here, when a methylxanthine is used, it is theophylline.

I don't know if your doctors are fully explaining your lung condition to you. It sounds like your asthma may evolved in COPD (Chronic Obstructive Pulmonary Disease). Are you using any inhaled medication?

Please get back to me with this information, and I'll see if I can help you .



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

QUESTION: Thanks for your reply and interests in my problems.The problems in India,regular physicans etc avoid more tests and time given to explain us is very less.When we ask more they tend to avoid and ignore as if everything we ask are only because of that is not our subject and to leAve evrything on them .
1 I am never smoker nor habituated of any habits.I donot drink.
2 Moreover i am one of the twins,my sister twin is also weak.I have been underweight since childhood and our food is totally vegetarian and we never thought seriously about it regd our health.
3 I am generally weak and never exposed to any area having chemical factories etc.I was computer engineering gradutes and worked only in Good enviorments conditions since earlier all computer systems used to have compalsory temperature conditions.
4 Rgd Torsemide i was told that to avoid more pressure on heart they prescribe mild doses of 5 mg or less.I found 2 / 3 physicains told me the same.
5 As per my pulmonolists lung condition is reversible.
6 my family doctor says everything is allergy related..may be dust,heat etc
7 I used to drink very less water but now i have started drinking 4 to 5 ltrs of water as per dr advise.
8 i have more dry skin than others and here climate is 40 celsius in summer and 10 to 15 celisus in winter.
9 I am over sensitive in nature,more emotional and gets stressful in bad conditions . I experience anxiety quite often

Anything more pl do ask me.I am very thankful to listen to me.

ANSWER: Hello again Sharad,

I don't know if the doctors choice of asthma medication is cost based, but the approach they are following was discarded in the US and much of western Europe over a decade ago. If you do not have insurance, then medications used today are costly. The US and Europe have similar guidelines, but there is also a globally based guideline set called GINA (Global INitiative for Asthma)

A mainstay therapy approach for persistent asthma is the use of inhaled corticosteroids on a daily basis, with step up additions to achieve control. The starting point of therapy is based upon the severity of the patient at the time of the initial evaluation. In your case, solely from what you tell me, I'd begin with a combination of a inhaled steroid/airway relaxer medication (in the US we have 3: Advair, Dulera and Symbicort, and added to that would be a nasal steroid spray. If you have sinus issues, when the sinuses are not controlled, they can also trigger breathing problems. Although you would begin to see improvement within the first few days, it takes a few months to greatly reduce the inflammation in the lungs. After 2-3 months, if progress is successful, then doctor may step back on the therapy to only using the inhaled oral steroid, with as needed supplementation of a shorter acting airway relaxer (salbuterol).

The fact you were in computers indicated to me your level of academic achievement, which is why I provided you with the guidelines to look at. Your physicians approach and their attitude would never be acceptable here. They would be held accountable for their poor performance and arrogant attitude. If it is possible that there is a university by you that has a medical school program, that may be a great destination to head to where your case would be looked at with interest in teaching future doctors.   

Regarding your nervousness, the Doxolin and Theophylline are cousins to caffeine, and can be contributing to your sense of nervousness. When on these drugs, they must be monitored for blood levels, because if too high, much greater side effects like you are experiencing, and if too low, do nothing.
I hope this further information helps you.

Feel free to get back to me if you have further questions.



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

QUESTION: !Thanks a lot for providing me all details and solution with patience.I am reAlly sorry not tipo inform you that I have been taking Inhaler 250 mg-Salmeterol and Fluticasone Propionate Powder as Rotahaler.I use it once or twice in a day at early, morning and before sleep.But i am not regular since i found it is ineffective nowadays.

Rgd your suggestions and  medication,i will definiteLy talk with my family dr as well as pulmonologist.T!hanks for your help .

I will be coming to San Diego / Los Angeles in next month.CanI talk with you that time with your permission.I can bring my papers

Hello again Sharad,
It is extremely important to use the fluticasone twice a day. It takes a full 6 months to reach maximum benefit of reducing lung inflammation. Also, has your pulmonologist ever have you demonstrate your ability to use the device correctly? Up to 75% of people are poorly trained on how to use the various devices, which in turn leads to treatment failure. Also, some patients respond better to one steroid over another due to genetics. Switching my benefit you more. Also, adding a steroid nasal spray could be critical. If the sinus passages are inflamed, they can trigger breathing attacks. When used, the spray is into the flare if the nostril, not up into the sinuses. This reduces the risk of nosebleeds and potential fungal infection in the sinuses
 Regarding the dust, I'll assume it is from a dry, outdoor environment.  There is a device called a HEPA filter. It is a room air filtration unit that sits on the floor and quietly filters out dust and pollen in the room about 30 times an hour. Many use this in their bedroom since overnight irritants have the strongest negative effect on breathing.
   Hope this is of greater benefit for you.



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Marc Rubin, RPh Asthma Educator


I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.


Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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