Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Welcome back to HCM!

Facing your mom's complex clinical scenario (CHF and asthma), I would like to explain that her recent shortness of breathing first should be evaluated in the light of CHF exacerbation.

Dyspnea when lying down and a moderately increased BNP raise strong suspicions on CHF aggravation option.

Coming to this point it is necessary to discuss with her cardiologist for a new medical checkup (a physical exam to investigate the severity of systemic congestion, as well as a cardiac ultrasound for reassessment of systolic and diastolic cardiac function, associated potential valvular dysfunctions, etc).

If sufficient evidence is drawn supporting heart failure deterioration, then CHF therapy optimization is necessary.

First of all, loop diuretics (furosemide, torasemide, etc.) should be part of the daily therapy leading to a significant improvement on clinical symptomatology.

In addition, judging by hemodynamic parameters (BP, heart rate, etc) adjustment of the daily doses of vasodilators, anti-arrhythmics should be sought.

It is also important to note that an increased BNP level may be explained by an acute inflammation/infection.

That's why it is necessary to check some lab tests:

- complete blood count,
- PCR,
- chest X ray study
- arterial blood gas analysis

If you haven't perform a checkup by her allergologist, I recommend you to discuss with him to possibly review the opportunity of adding any other bronchodilator (preferably a long acting one) for better controlling a possible bronchial hyperactivity.

So, to conclude my suggestion would be regarding:

(1) reviewing with your cardiologist the beneficial effects of loop diuretics addition,
(2) exclude a possible acute inflammation/infection (pulmonary, etc) which would be totally curable be an appropriate antibiotics regimen.
(3) optimization of asthma therapy.

A thorough discussion with your mom's attending doctor could lead to the optimal management strategy.

Hope to have been helpful to you!

In case of further uncertainties, feel free to ask me!

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion:

Detailed Answer:

Hi again,

Your mom's renal function implies a prolonged (chronic) use of loop diuretics (lasix, etc), as well as a periodic close renal function follow up, to assure a satisfactory body fluids elimination.

So, a trial of increased diuretic dose of two days would be insufficient.

Regarding your mom's lung therapy, I would say that flovent when taken under doctor's prescription and supervision is safe. So don't be afraid to use it!

When I advised you to discuss with her doctor for possibly adding other bronchodilators, I meant also long acting bronchodilators (which in fact are not steroids), like salmeterol. formoterol, etc.

I would like to emphasize that a cardiac ultrasound investigation would be of great help in determining whether diuretics are necessary, and also the alternative reasons (pulmonary) of her complaints.

Regards,

Dr. Iliri

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