62 yr Female, DM,HT, was on BIPAP at home , She was being managed at the best hospital of Ahmedabad. She needed frequent ICU admission due to breathlessness . She was diagnosed to be asthmatics , was send from hospital to home after 20 days of admission. Relative called me to see her home as she was breathless at home while seating or lying . Was not able to say a single word.
In my visit to her home I found her breathless, coughing continuously ,HR 120, BP 140/90 ( AMLODIPINE 10 MG, MINIPRESS XL(TDS) & OLMIN-H40, SPO2-92% (RA) and BIPAP, RBS WAS VARYING ( 300-450) ON OHA AND LANTUS, ,B/L TENSE PEDAL EDEMA
FOR ASTHMA SHE WAS ADVISED – MEDROL 6MG, FORACORT PUMP, IPRAVENT PUMP, AND BIPAP, DERIPHYLLINE TABS.
SO SHE WAS SO SICLE AT THE TIME OF DISCHARGE, STILL SHE WAS SEND HOME, AND THAT IS REASON CALLED ME KNOW IF I CAN DO ANYTHING OR PATIENT IS DESTINED
THID COURSE ONLY.
My 1 st target was to confirm diagnosis, find the severity of the problem, look for cause and find precipitating factors.
Adv- PFT, CBC, LFT,RFT,URIC ACID , D-DIMER, PRO BNP, ALLRGIC TEST ,IGE,.SPTUTUM EXAMINATION
ALL THESE REPORTS I GOT DONE AT HOME ONLY.
PFT confirmed severe reversible airway obstruction , PEFR 0.60-( CRTICAL RESPIRATORY FAILURE)
ABG- CONSITENT WITH HYPOXIC RESIRATORY FAILURE AND PCO 49- ( VERY HIGH IN ASTHMA AS THEY HAVR LOW PCO2), pH-7.34
SPUTUM POSITIVE FOR FUNGAL HYPHAE – ASPERGILOUS
D-DIMER 4800,
TLC- 16000.
PRO-BNP 400,URIC ACID 7.5.
ALLERGIC TEST POSTIVE –
IGE HIGH ( 435 IU)
For Asthma- I STOPPED BIPAP AND PUT HER ON HOME OXYGEN THERAPY.
We have started on nebulizer( as patient in not candidate for inhaler or rotacap)-duoline, budicot, foracort and tab wysolone 20 mg.. Tobamist , montigress -LC, ACEBROPHYLLINE & VONAZ (200MG BD).
AS IGE WAS HIGH – I HAVE PUT HER ON SC DOSE OF BOLSTRAN AS PER BODY WEIGHT AND IGE.
HER BP WAS HIGH ON THREE DRUG DUE TO RESPIRATORY DISTRESS. WE CHANGE TO CILINDAPINE 10MG BD, OLMINE H 40 . I COULD STOP HER MINIPRESS XL.
FOR DM -WE HAVE PUT HER LANTUS -3 DOSE AND NOVARAPID AAER PER SCALE. AFTER 7 DAYS -her PEFR rose to 1.25, cough decreased to 50%, could walk and speak.
We started home rehabilitation program for her and after 4 week, her PEFR ROSE 1.85-2.0. COUGH GONE. SUGAR CONTROL AND BP CONTROL.
DX- INTRACTABLE ASTHMA, WITH ASPERGILLOUS INFECTION, UNCONTROLLED DM, AND HYPERTENSION.
NOW I AM WAITING HER PEFR TO IMPROVE TO 2.25 SO I CAN GO FOR BRONCHIAL THROMOPLASTY
