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What Does This X-ray Report For Difficulty Breathing Indicate?
Question: Hi, I m 50 and asthmatic ( since a child) on regular salbutamol and seretide 250. Stopped smoking 8 weeks ago, but have needed 3 courses of 5 day prednisolone since due to several asthma attacks... breathing feels ok in between courses then flares again ( feel very hypersensitive to dust and dogs, but sometimes trigger unknown) had lower lobe pneumonia here back in Feb ... three courses of antibiotics to get rid of it but have still had a slight niggly pain here since. Xray yesterday ay A and E ( following two attacks this weekend) shows hyperinflation and very small area of blunt costal margin on one lung ? pleural effusion. No infection, normal blood results.Any idea why this is happening and when my breathing will improve?
Brief Answer:
Asthma vs COPD to be confirmed. Add Tiotropium
Detailed Answer:
Hello,
Welcome and thanks for your query.
First of all I congratulate you on your decision to stop smoking because it is the most harmful thing that a person with asthma can do. Have you had a spirometry ( lung function test) done recently. If so please upload the result. If not a baseline and a post bronchodilator test would show your response to a bronchodilator. This way I would be able to differentiate between asthma and COPD which you are prone to.
If you have COPD, you could use Spiriva (tiotropium) which would help you more and taper your prednisolone down. Prednisolone decreases your immunity and makes you more prone for infections like pneumonia and decreases the effect of antibiotics.
If you are very symptomatic, you can add on Spiriva and have your spirometry later.
I hope you will stick to your resolution to stop smoking ( including second hand)
Best wishes,
Asthma vs COPD to be confirmed. Add Tiotropium
Detailed Answer:
Hello,
Welcome and thanks for your query.
First of all I congratulate you on your decision to stop smoking because it is the most harmful thing that a person with asthma can do. Have you had a spirometry ( lung function test) done recently. If so please upload the result. If not a baseline and a post bronchodilator test would show your response to a bronchodilator. This way I would be able to differentiate between asthma and COPD which you are prone to.
If you have COPD, you could use Spiriva (tiotropium) which would help you more and taper your prednisolone down. Prednisolone decreases your immunity and makes you more prone for infections like pneumonia and decreases the effect of antibiotics.
If you are very symptomatic, you can add on Spiriva and have your spirometry later.
I hope you will stick to your resolution to stop smoking ( including second hand)
Best wishes,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
usual peak flow in morning 280-290 post broncho dilator 340 - 348 XXXXXXX
Recent spirometry said 13% reversibility... but felt like I was having an attack when having XXXXXXX test as had no medication for 12 hours .... reversal from attack attack is always much longer than the 15 mins in the waiting room to repeat test and actually wasn't back to normal l until well over an hour at home later... I would say that it probably didn't really count for much. Would the two attacks this weekend from exposure to dog hair and dust suggest asthma? Why are my airways more reactive since I stopped smoking? I have no cough but seem to be swallowing more clear, frothy mucus/phlegm after attacks....
Recent spirometry said 13% reversibility... but felt like I was having an attack when having XXXXXXX test as had no medication for 12 hours .... reversal from attack attack is always much longer than the 15 mins in the waiting room to repeat test and actually wasn't back to normal l until well over an hour at home later... I would say that it probably didn't really count for much. Would the two attacks this weekend from exposure to dog hair and dust suggest asthma? Why are my airways more reactive since I stopped smoking? I have no cough but seem to be swallowing more clear, frothy mucus/phlegm after attacks....
Brief Answer:
Tiotropium is worth a try
Detailed Answer:
Please let me know the FVC and the FEV1 as percentage of the expected normal for age, sex , height and weight. 13% improvement is borderline and the absolute increase in terms of millilitres is also important.
If you have the report, please upload it.
Attacks on exposure to dog hair would suggest asthma.
The increase in phlegm is due to increased secretion and more clearing of the respiratory tract by the cilia that are regaining their function after you stopped smoking.
I think Spiriva would help if you can get it prescribed.
Tiotropium is worth a try
Detailed Answer:
Please let me know the FVC and the FEV1 as percentage of the expected normal for age, sex , height and weight. 13% improvement is borderline and the absolute increase in terms of millilitres is also important.
If you have the report, please upload it.
Attacks on exposure to dog hair would suggest asthma.
The increase in phlegm is due to increased secretion and more clearing of the respiratory tract by the cilia that are regaining their function after you stopped smoking.
I think Spiriva would help if you can get it prescribed.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Since yesterday the pain along my left lower ribs into my back feels more obvious worse in my back ... after xray at A&E on Sunday they said there was costophrenic blunting on xray ( anterior view... didnt do lateral view) Could this be plural effusion from the pneumonia I had in February.. had a niggly pain there since pneumonia... could this be triggering my asthma?
Brief Answer:
Can contribute to breathlessness depending on the extent
Detailed Answer:
The blunting of the costophrenic angle can be from a pleural effusion or from pleural thickening. If the shadow changes with posture it is fluid. Thickening does not change with position. If it is fluid it may be aspirated and analysed.
Pleural thickening can last for many months. Effusion would change with time either increase or decrease and disappear.
From the persistence of the pain for several months, it is likely to be a pleural thickening. This can decrease the compliance of the lungs if it is large and may contribute to breathlessness.
Can contribute to breathlessness depending on the extent
Detailed Answer:
The blunting of the costophrenic angle can be from a pleural effusion or from pleural thickening. If the shadow changes with posture it is fluid. Thickening does not change with position. If it is fluid it may be aspirated and analysed.
Pleural thickening can last for many months. Effusion would change with time either increase or decrease and disappear.
From the persistence of the pain for several months, it is likely to be a pleural thickening. This can decrease the compliance of the lungs if it is large and may contribute to breathlessness.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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