What Does Poor Pulmonary Function Post Treatment Indicate?

Posted on Fri, 16 Jan 2015

Question: My daughter is age 6 and has had very poor pulmonary function test results for 2 years. She's been seeing a pediatric pulmonary doctor after she had 4 bouts of pneumonia in one year 3 years ago. She had a bronchoscopy that found nothing significant other than a small nodule on her vocal chord that indicated she had some reflux. Her allergy testing came back normal. Her immunology testing came back normal. She was recently tested for Cystic Fibrosis and that was also normal.

She's now on: Advair HFA 115 twice daily; Singulair 5mg once daily; Nexium granules 10mg once daily; Flonase 50mcg once daily; Ventolin HFA 90mcg as needed 20-30 minutes prior to activity and Albuterol breathing treatments via nebulizer as needed every 4-6 hours. Despite this her pulmonary function is still poor. We've had to follow up with the doctor every 30 days for the last 7 months. This seems to be very frequent, as though there is something the doctor is concerned about, but not saying.

Are there any other tests you would recommend?

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
Looks like uncontrolled asthma - or ILD

Detailed Answer:
Hi...By what you quote the history and the medicines you are using are fitting into uncontrolled sever persistent asthma or Interstitial Lung Disease (ILD)
I have a few questions for you -
Questions:
1. How many days per month does she cough or feel breathless?
2. How many nights per month does her sleep get disturbed due to above symptoms?
3. Does she feel breathless when she runs around or plays with other kids?
4. Are the symptoms when there are seasonal changes?
5. Is there any family history of asthma or any other sort of allergies like skin allergy etc.?
6. Is the cough always associated with fever?

Kindly get back to me with answers to above questions. I will further proceed based on that.
Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sumanth Amperayani (1 hour later)

I'm trying to answer the questions but it's difficult on my phone.
1. She coughs often after activities. She's really unable to say how breathless she feels. She develops purple circles under her eyes and we can see them.
Continued

Answered by Dr. Sumanth Amperayani (13 minutes later)

Brief Answer:
I need all answers to grade the severity please

Detailed Answer:
Hi...I need all the answers to grade the severity please. I am very sorry to trouble you.
If it is not possible to answer all the questions from the phone, I suggest you do it from your computer or laptop as this is not an emergency. But it is imperative that I need to know all the answers to grade the severity of the illness and at the same time, I may even ask for some more information after I get the answers to decide on differential diagnosis please.

I also request you to upload all medical reports on right side of your dashboard. So I can suggest you further tests according to reports.

Regards - Dr. Sumanth

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju