Hello doctor, My mother is 62 years old. She is a diabetic on OHA and under good glycemic control. She weighs about 56 kg. She is suffering from a dry cough for four months now. The chest x-ray is normal and ENT consultation also ruled out any local cause. She complaints of tickling sensation and coughs following it. Coughing even wakes her from sleep at night. Blood Investigations done had all findings within normal limits except for high eosinophil count. Spirometry was done with the following results: % values pre-inhalation are: FVC 60.47 FEV1 63.18 FEV1/FVC 113 PEF 68.89 FEF (25-75) 59.25. % values after inhalation: FVC 70.60 FEV1 71.72 FEV1/FVC 110 PEF 70.7 FEF (25-75) 54.43. After this, the treatment was started with a diagnosis of moderate restrictive and obstructive lung disease. She is currently on Budamate 200 trans caps one in the morning through lupihaler. Budate 200 and Triohale transcap one cap each through inhaler at night, tablet AB Phylline one tablet daily at 8 PM. But, her symptoms improve intermittently and again recur spontaneously. Kindly suggest what to do?
Hello. I have seen the PFT (pulmonary function test) report of your mother. (attachment removed to protect patient identity).  Let me tell you first that the PFT test is not done properly as post-test is done immediately only after four minutes of the pre-test. Ideally, we do it after 15 minutes. So we cannot rely on this PFT report. Even if we see at the report, it shows moderate obstruction and no bronchodilator reversibility. So it goes more in favor of COPD (chronic obstructive pulmonary disease). The treatment of COPD is mainly bronchodilator drugs by inhaler route. So I suggest to stop Budamate, Budate and Triohale rotacaps. Start Foracort inhaler (400) with Zerostat spacer two puffs twice daily morning and evening, and Duova inhaler with spacer two puffs only in the morning. Continue tablet AB Phyllin 200 one tablet daily. If she feels too breathless after any type of exertion she can take, Duolin inhaler by spacer two puffs as required. Strict sugar control is advised. I hope this helps.